Document Detail


The protective status of subtotal obliteration of arteriovenous malformations after radiosurgery: significance and risk of hemorrhage.
MedLine Citation:
PMID:  19834376     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Arteriovenous malformations (AVMs) treated by radiosurgery with complete obliteration of the nidus but a persisting early draining vein on follow-up angiography can be termed subtotally obliterated. However, these are persistent circulating AVMs. The significance of these lesions, their hemorrhage rate, and their management are analyzed. METHODS: In a series of 862 consecutive patients with AVMs treated by radiosurgery, 121 patients (14%) achieved subtotal obliteration (STO). The angiographic evolution and rate of obliteration were studied. The pretreatment angiographic features, dosimetric parameters, and postradiosurgery hemorrhage rate were compared with those in the rest of the treated population. Finally, the options for follow-up and treatment were analyzed. RESULTS: Of 121 subtotally obliterated AVMs, the bleeding rate was 0%; 53% of patients achieved complete obliteration. This occurred in 71% of those who had STO at 1 year. In the cases in which STO was detected at 2, 3, and 4 years, total obliteration eventually occurred in 43%, 28.5%, and 0%, respectively. Comparative analysis with AVMs in which a part of the nidus persisted showed a significant difference in the bleeding rate. Except for volume, no significant statistical difference in angiographic and dosimetric parameters was found between the STO group and the rest of the studied population with residual nidus. Six cases received further treatment, resulting in 2 cures and 2 treatment-related complications. CONCLUSION: Subtotally obliterated AVMs are different from other partially obliterated AVMs, with a 0% bleeding rate. Their complete obliteration is a function of delay of appearance on follow-up angiography. Invasive follow-up and further treatment of these AVMs do not seem warranted.
Authors:
Zuair Abu-Salma; Fran??ois Nataf; May Ghossoub; Michel Schlienger; Jean-Fran??ois Meder; Emmanuel Houdart; Fran??ois-Xavier Roux
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  65     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2010-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  709-17; discussion 717-8     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Centre Hospitalier Sainte-Anne, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cerebral Angiography / standards
Cerebral Arteries / abnormalities,  physiopathology,  surgery
Cerebral Hemorrhage / epidemiology*,  physiopathology,  prevention & control
Cerebral Veins / abnormalities,  physiopathology,  surgery
Child
Comorbidity
Female
Humans
Intracranial Arteriovenous Malformations / epidemiology*,  physiopathology,  surgery*
Male
Middle Aged
Postoperative Hemorrhage / epidemiology*,  physiopathology,  prevention & control
Radiation Dosage
Radiosurgery / statistics & numerical data*
Radiotherapy Planning, Computer-Assisted
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult

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


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