Document Detail


Stereotactic radiosurgery in the management of angiographically occult vascular malformations.
MedLine Citation:
PMID:  11316556     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate the role of stereotactic radiosurgery in the treatment of angiographically occult vascular malformations (AOVMs). METHODS AND MATERIALS: From 1987 to 1996, 21 patients, 10 males and 11 females, median age of 41 years (range: 7-75 years), with an intracerebral AOVM underwent stereotactic radiosurgery at our institution. All were considered at high risk for surgical intervention. The vascular lesions were located in the brainstem (17 patients), basal ganglia (2), occipital lobe (1), and cerebellum (1). Diagnosis was based on high-resolution magnetic resonance imaging (MRI). Clinical presentation at onset included previous intracerebral hemorrhage (20 patients) and epilepsy (1). All patients were treated with a linac-based radiosurgical technique. The median dose delivered was 25 Gy (range 13-50 Gy), typically prescribed to the 80-90% isodose surface (range 50-90%), which corresponded to the periphery of the vascular malformation. Patients were followed by clinical neurologic assessment and by MRI on a regular interval basis. RESULTS: Follow-up was obtained in 20 patients; clinical or MRI information was not available for 1 patient, and this patient was excluded from our analysis. At a median follow-up of 77 months (range: 4-141 months), follow-up MRIs postradiosurgery do not demonstrate any changes in the appearance of the AOVM. Four patients developed an intracranial bleed at 4, 8, 35, and 57 months postradiosurgery. Annual hemorrhage rates were considerably higher in the observation period preradiosurgery than postradiosurgery (30% vs. 3.2%, p < 0.001). Complications postradiosurgery were observed in 4 patients. Three patients developed mild to moderate edema surrounding the radiosurgical target, expressed at 5, 8, and 24 months, respectively. In all cases, the edema was transient and resolved completely on subsequent MRIs. One of the 4 patients developed radiation necrosis 8 months after radiosurgery. CONCLUSION: The use of stereotactic radiosurgery in the treatment of AOVM continues to be controversial. Our results appear to show a reduction in the risk of symptomatic hemorrhage post treatment. Patients with previous history of hemorrhage or progressive neurologic deficit and small, well circumscribed lesions may benefit from a trial of stereotactic radiosurgery.
Authors:
C Tsien; L Souhami; A Sadikot; A Olivier; R del Carpio-O'Donovan; R Corns; H Patrocinio; W Parker; E Podgorsak
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  50     ISSN:  0360-3016     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-04-24     Completed Date:  2001-05-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  133-8     Citation Subset:  IM    
Affiliation:
Department of Radiation Oncology, McGill University Hospital Center, Montreal, Quebec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / surgery*
Male
Middle Aged
Radiosurgery / adverse effects,  methods*
Treatment Outcome

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


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