Abstract
Purpose. Arteriovenous malformations (AVMs) in the basal ganglia and thalamus have a more aggressive natural history with a higher morbidity and mortality than AVMs in other locations. Optimal treatment—complete obliteration without new neurological deficits—is often challenging. We present a patient with a large bilateral basal ganglia and thalamic AVM successfully treated with hypofractionated stereotactic radiosurgery (HFSRS) with intensity modulated radiotherapy (IMRT). Methods. The patient was treated with hypofractionated stereotactic radiosurgery to 30 Gy at margin in 5 fractions of 9 static fields with a minimultileaf collimator and intensity modulated radiotherapy. Results. At 10 months following treatment, digital subtraction angiography showed complete obliteration of the AVM. Conclusions. Large bilateral thalamic and basal ganglia AVMs can be successfully treated with complete obliteration by HFSRS with IMRT with relatively limited toxicity. Appropriate caution is recommended.
Highlights
Arteriovenous malformations (AVMs) in the basal ganglia and thalamus comprise a small percentage of all AVMs [1,2,3,4]
We present a patient with a large bilateral basal ganglia and thalamic AVM successfully treated with hypofractionated stereotactic radiosurgery (HFSRS) with intensity modulated radiotherapy (IMRT)
We describe the successful treatment of a pediatric patient with complete obliteration by HFSRS with IMRT for his large bilateral basal ganglia and thalamic AVM
Summary
Arteriovenous malformations (AVMs) in the basal ganglia and thalamus comprise a small percentage of all AVMs [1,2,3,4]. These deep AVMs have a more aggressive natural history with a higher morbidity and mortality than AVMs in other locations [5]. We present a patient with a large bilateral basal ganglia and thalamic AVM successfully treated with hypofractionated stereotactic radiosurgery (HFSRS) with intensity modulated radiotherapy (IMRT). There have been no other case reports of bilateral AVMs of this size successfully treated with radiosurgery. The complete obliteration of the AVMs after HFSRS with one year of treatment is noteworthy
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