Document Detail


Long-term outcomes of stereotactic radiosurgery for arteriovenous malformations in the thalamus.
MedLine Citation:
PMID:  20644425     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Arteriovenous malformations (AVMs) in the thalamus carry a high risk of hemorrhage. Although stereotactic radiosurgery (SRS) is widely accepted because of the high surgical morbidity and mortality of these lesions, precise long-term outcomes are largely unknown.
OBJECTIVE: To review our experience with SRS for thalamic AVMs based on the latest follow-up data.
METHODS: Forty-eight patients with thalamic AVMs were treated by SRS using the Leksell Gamma Knife and were followed. Long-term outcomes including the obliteration rate, hemorrhage after treatment, and adverse effects were retrospectively analyzed.
RESULTS: The annual hemorrhage rate before SRS was 14%. The mean follow-up period after SRS was 66 months (range 6-198 months). The actuarial obliteration rate confirmed by angiography was 82% at 5 years after treatment, and the annual hemorrhage rate after SRS was 0.36%. Factors associated with higher obliteration rates were previous hemorrhage (P = .004) and treatment using new planning software (P = .001). Persistent worsening of neurological symptoms was observed in 17% and more frequently seen in patients who were treated using older planning software (P = .04) and a higher margin dose (P = .02). The morbidity rate for patients who received treatment planned using new software with a margin dose not more than 20 Gy was 12%.
CONCLUSION: SRS for thalamic AVMs achieved a high obliteration rate and effectively decreased the risk of hemorrhage, with less morbidity compared with other modalities. Longer follow-up to evaluate the risk of delayed complications and the effort to minimize the morbidity is necessary.
Authors:
Tomoyuki Koga; Masahiro Shin; Keisuke Maruyama; Atsuro Terahara; Nobuhito Saito
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  67     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-20     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  398-403     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan. kouga-tky@umin.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cerebral Hemorrhage / etiology
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / surgery*
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Middle Aged
Nervous System Diseases / etiology
Postoperative Complications / epidemiology
Radiosurgery* / adverse effects
Retrospective Studies
Thalamus / blood supply,  surgery*
Tomography, X-Ray Computed
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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