Document Detail

Outcome after hemorrhage following Gamma Knife surgery for cerebral arteriovenous malformations.
MedLine Citation:
PMID:  19199449     Owner:  NLM     Status:  MEDLINE    
OBJECT: Although the effects of Gamma Knife surgery (GKS) on the risk of hemorrhage are poorly understood, a certain subset of patients does suffer bleeding after GKS. This study was undertaken to analyze the outcome of patients sustaining hemorrhage after GKS; it is the most feared complication of radiosurgical management of cerebral arteriovenous malformations (AVMs). METHODS: Between May 1997 and June 2006, 494 cerebral AVMs in 489 patients were treated using a Leksell Gamma Knife Model B, and follow-up evaluations were conducted until June 2007 at the All India Institute of Medical Sciences in New Delhi. Fourteen patients who sustained a hemorrhage after GKS formed the study group. In most of these patients conservative management was chosen. RESULTS: The mortality rate was 0% and there was a 7% risk of sustaining a severe deficit following rebleeding after GKS. None of the patients sustained rebleeding after complete obliteration. Patients with Spetzler-Martin Grade III or less had increased chances of hemorrhage after GKS (p < 0.002). The presence of deep venous drainage, aneurysm, venous hypertension, or periventricular location on angiography was common in patients with hemorrhage after GKS. CONCLUSIONS: The risk of hemorrhage that remains following GKS for cerebral AVMs is highest in the 1st year after treatment. The present study showed a relatively good outcome even in cases with hemorrhage following GKS, with no deaths and minimal morbidity, further substantiating the safety and efficacy of the procedure.
Manish Kumar Kasliwal; Shashank Sharad Kale; Aditya Gupta; Narayanam Anantha Sai Kiran; Manish Singh Sharma; Bhawani Shanker Sharma; Ashok K Mahapatra
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  110     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-19     Completed Date:  2009-06-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1003-9     Citation Subset:  AIM; IM    
Gamma Knife Unit, Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
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MeSH Terms
Cerebral Hemorrhage / etiology*,  mortality
Child, Preschool
Intracranial Arteriovenous Malformations / surgery*
Middle Aged
Postoperative Complications

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