Document Detail

Optimal timing for Gamma Knife surgery after hemorrhage from brain arteriovenous malformations.
MedLine Citation:
PMID:  19123891     Owner:  NLM     Status:  MEDLINE    
OBJECT: Optimal timing of Gamma Knife surgery (GKS) after hemorrhage from brain arteriovenous malformations (AVMs) is unclear and of concern to neurosurgeons because GKS is usually performed after absorption of the hematoma. The authors investigated whether waiting for hematoma absorption is beneficial and aimed to clarify the optimal treatment timing. METHODS: The authors retrospectively studied 211 patients with AVMs who presented with hemorrhage and underwent GKS as the initial treatment. Patients were categorized into 3 groups according to the interval between the time of first hemorrhage and GKS, as follows: Group 1, 0-3 months (70 patients); Group 2, 3-6 months (62 patients); and Group 3, > 6 months (79 patients). The obliteration rates, number of hemorrhages before and after GKS, and complication rates were compared between these 3 groups. The authors also analyzed a subgroup of 127 patients who presented with intracerebral hemorrhage (ICH) to identify the influence of ICH on outcome. RESULTS: After a median follow-up of 6.3 years, the rates of obliteration, hemorrhage after treatment, and complication were not significantly different between the 3 groups even though the patients with a longer interval before GKS (Group 3) had more AVMs in eloquent areas and neurological deficits. However, the numbers of patients with preoperative hemorrhage in the interval before GKS was significantly higher in Group 3 (1, 3, and 20 patients in Group 1, 2, and 3, respectively). These results were similar in the analyses of 127 patients presenting with ICH. CONCLUSIONS: No benefit was detected in waiting for hematoma absorption until GKS after hemorrhage from AVM. Because of higher hemorrhagic risk until GKS > 6 months after hemorrhage, the authors recommend GKS within 6 months after hemorrhage.
Keisuke Maruyama; Tomoyuki Koga; Masahiro Shin; Hiroshi Igaki; Masao Tago; Nobuhito Saito
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  109 Suppl     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2009-01-06     Completed Date:  2009-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  73-6     Citation Subset:  AIM; IM    
Departments of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
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MeSH Terms
Cohort Studies
Hematoma / etiology,  pathology,  surgery*
Intracranial Arteriovenous Malformations / complications,  surgery*
Intracranial Hemorrhages / etiology,  pathology,  surgery*
Radiosurgery / methods*
Radiotherapy Dosage
Retrospective Studies
Time Factors
Treatment Outcome

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

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