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Stereotactic radiosurgery after embolization for arteriovenous malformations.
MedLine Citation:
PMID:  23258513     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
We sought to define the long-term benefits and risks of stereotactic radiosurgery (SRS) for arteriovenous malformation (AVM) patients who underwent prior embolization. Between 1987 and 2006, we performed Gamma Knife® SRS on 120 patients with AVM who underwent embolization followed by SRS. Sixty-four patients (53%) had at least 1 prior hemorrhage. The median number of embolizations varied from 1 to 5. The median target volume was 6.6 cm(3) (range, 0.2-26.3 cm(3)). The median margin dose was 18 Gy (range, 13.5-25 Gy). After embolization, 25 patients (21%) developed symptomatic neurological deficits. The overall rates of total obliteration documented by either angiography or magnetic resonance imaging were 35, 53, 55 and 59% at 3, 4, 5 and 10 years, respectively. Nine patients (8%) had a hemorrhage during the latency interval and 7 patients died due to hemorrhage. The actuarial rates of AVM hemorrhage after SRS were 0.8, 3.5, 5.4, 7.7 and 7.7% at 1, 2, 3, 5 and 10 years, respectively. Permanent neurological deficits due to adverse radiation effects developed in 3 patients (2.5%) after SRS. Using a case-match control technique, we found that embolization prior to SRS was associated with a lower rate of total obliteration (p = 0.028) in comparison to radiosurgery alone. In this 20-year experience, we found that prior embolization reduced the rate of total obliteration after SRS and latency interval hemorrhage risks were not affected by prior embolization. In the future, the role of embolization after SRS should be explored.
Authors:
Hideyuki Kano; Douglas Kondziolka; John C Flickinger; Kyung-Jae Park; Aditya Iyer; Huai-Che Yang; Xiaomin Liu; Edward A Monaco Iii; Ajay Niranjan; L Dade Lunsford
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Publication Detail:
Type:  Journal Article     Date:  2012-12-11
Journal Detail:
Title:  Progress in neurological surgery     Volume:  27     ISSN:  1662-3924     ISO Abbreviation:  Prog Neurol Surg     Publication Date:  2013  
Date Detail:
Created Date:  2012-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0076033     Medline TA:  Prog Neurol Surg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  89-96     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 S. Karger AG, Basel.
Affiliation:
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA.
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