Abstract
ObjectiveWe retrospectively analyzed our experience with time-staged gamma knife stereotactic radiosurgery (GKS) in treating large arteriovenous malformation(AVM)s;≥ 10 cm3).MethodsForty-five patients who underwent time-staged GKS (2-stage, n = 37;3-stage,n = 8) between March 1998 and December 2011 were included. The mean volume treated was 20.42±6.29 cm3 (range, 10.20–38.50 cm3). Obliteration rates of AVMs and the associated complications after GKS were evaluated.ResultsMean AVM volume (and median marginal dose) at each GKS session in the 37 patients who underwent 2-stage GKS was 19.67±6.08 cm3 (13 Gy) at session 1 and 6.97±6.92 cm3 (17 Gy) at session 2. The median interval period was 39 months. After follow-up period of 37 months, the complete obliteration rate was 64.9%. The mean AVM volume (and median marginal dose) at each GKS session in the 8 patients who underwent 3-stage GKS was 23.90±6.50 cm3 (12.25 Gy), 19.43±7.46 cm3 (13.5 Gy), 7.48±6.86 cm3 (15.5 Gy) at session 1, 2, and 3, respectively. The median interval duration between each GKS session was 37.5 and 38 months, respectively. After a median follow-up period of 47.5 months, 5 patients (62.5%) achieved complete obliteration. Postradiosurgical hemorrhage developed in 5 patients (11.1%) including one case of major bleeding and 4 cases of minor bleeding. No patient suffered from clinically symptomatic radiation necrosis following radiation.ConclusionTime-staged GKS could be an effective and safe treatment option in the management of large AVMs.
Highlights
Arteriovenous malformation (AVM) is the second most common cause of intracerebral hemorrhage in people
The management of large AVMs remains challenging, and patients with large and, asymptomatic AVMs are usually managed conservatively because the risk associated any intervention including embolization, surgical resection, and/or radiosurgery may be equal to or greater than that arising from the natural history of the AVM if left untreated
stereotactic radiosurgery (SRS) has been used as the alternative option, its use is limited; single-stage SRS for large volume AVMs is associated with a low rate of obliteration or unacceptable adverse radiation effects (AREs)
Summary
Arteriovenous malformation (AVM) is the second most common cause of intracerebral hemorrhage in people
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