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Radiosurgical considerations in the treatment of large cerebral arteriovenous malformations.
MedLine Citation:
PMID:  19893730     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In order to establish the role of Gamma Knife radiosurgery (GKS) in large intracranial arteriovenous malformations (AVMs), we analyzed clinical characteristics, radiological features, and radiosurgical outcomes.
METHODS: Between March 1992 and March 2005, 28 of 33 patients with large AVMs (> 10 cm(3) in nidus-volume) who were treated with GKS underwent single session radiosurgery (RS), and the other 5 patients underwent staged volumetric RS. Retrospectively collected data were available in 23 cases. We analyzed treatment outcomes in each subdivided groups and according to the AVM sizes. We compared the estimated volume, defined as primarily estimated nidus volume using MR images, with real target volume after excluding draining veins and feeding arteries embedded into the nidus.
RESULTS: Regarding those patients who underwent single session RS, 44.4% (8/18) had complete obliteration; regarding staged volumetric RS, the obliteration rate was 40% (2/5). The complete obliteration rate was 60% (6/10) in the smaller nidus group (10-15 cm(3) size), and 25% (2/8) in the larger nidus group (over 15 cm(3) size). One case of cerebral edema and two cases (8.7%) of hemorrhage were seen during the latent period. The mean real target volume for 18 single sessions of RS was 17.1 cm(3) (10.1-38.4 cm(3)), in contrast with the mean estimated volume of 20.9 cm(3) (12.0-45.0 cm(3)).
CONCLUSION: The radiosurgical treatment outcomes of large AVMs are generally poor. However, we presume that the recent development in planning software and imaging devices aid more accurate measurement of the nidus volume, therefore improving the treatment outcome.
Authors:
Sung Ho Lee; Young Jin Lim; Seok Keun Choi; Tae Sung Kim; Bong Arm Rhee
Publication Detail:
Type:  Journal Article     Date:  2009-10-31
Journal Detail:
Title:  Journal of Korean Neurosurgical Society     Volume:  46     ISSN:  1598-7876     ISO Abbreviation:  J Korean Neurosurg Soc     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-11-06     Completed Date:  2011-07-14     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  101467054     Medline TA:  J Korean Neurosurg Soc     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  378-84     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea.
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