Document Detail

Radiosurgery for basal ganglia, internal capsule, and thalamus arteriovenous malformation: clinical outcome.
MedLine Citation:
PMID:  15617586     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Radiosurgery is accepted as the first option for treating deep arteriovenous malformations (AVMs), although the clinical outcome in this subgroup of brain AVMs is not well studied. The objective of this study is to review our experience with radiosurgical treatment for these AVMs. METHODS: Between October 1989 and December 2000, 45 patients with deep AVMs (including basal ganglia, internal capsule, and thalamus) underwent stereotactic radiosurgery. Three patients were lost to follow-up and therefore were excluded from this study. Patient characteristics and outcomes were collected and analyzed. The obliteration prediction index and the radiosurgery-based AVM score were calculated and tested. RESULTS: Forty-two patients were followed up for a median of 39 months (range, 25-90 mo; mean, 45.8 mo). The median maximum AVM diameter during the radiosurgery was 1.8 cm (range, 0.9-4.0 cm; mean, 2.07 cm), and the median AVM volume was 2.8 cm(3) (range, 0.2-18.3 cm(3); mean, 4.74 cm(3)). The mean marginal dose was 16.2 Gy (median, 15 Gy), and the median maximum dose was 22.4 Gy (range, 16.6-30 Gy). The AVM cure rate after the first radiosurgical treatment, using angiography- and magnetic resonance imaging-confirmed obliteration, was 61.9%. The predicted obliteration using the obliteration prediction index was 60%. Eight patients developed radiation-induced complications (19%). The deficit was transient in three patients (7.1%) and permanent in five patients (11.9%). The risk of postradiosurgical hemorrhage in this cohort was 9.5% for the first year, 4.7% for the second year, and 0% thereafter. Excellent outcome (obliteration plus no new deficit) was achieved in 70% of the patients in the group with radiosurgery-based AVM score less than 1.5 compared with 40.9% in the group with radiosurgery-based AVM score greater than 1.5% (P = 0.059). CONCLUSION: Radiosurgery for deep AVMs has a satisfactory obliteration rate and acceptable morbidity, considering the risk of hemorrhage without treatment and the risk of morbidity associated with other treatment modalities.
Yuri M Andrade-Souza; Gelareh Zadeh; Daryl Scora; May N Tsao; Michael L Schwartz
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  56     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2005  
Date Detail:
Created Date:  2004-12-24     Completed Date:  2006-05-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  56-63; discussion 63-4     Citation Subset:  IM    
Division of Neurosurgery, Sunnybrook and Women's College, Health Science Centre,University of Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Basal Ganglia / blood supply*
Child, Preschool
Follow-Up Studies
Internal Capsule / blood supply*
Intracranial Arteriovenous Malformations / surgery*
Middle Aged
Postoperative Complications / epidemiology,  etiology
Radiosurgery* / adverse effects
Thalamus / blood supply*
Treatment Outcome

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

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