Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformations

俊介, 河本; 富男, 佐々木; 公朋, 高倉; 敦朗, 寺原; 徹, 町田

doi:10.2335/scs1987.20.5_375

Cited by 3 publications

(10 citation statements)

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“…The most important factor predicting incomplete nidus obliteration after a single GKS session is the lower dose treatment necessitated by relatively large nidus volumes. 5,6,12,15,16,21,23,26,37 Pan et al 18 reported an obliteration rate of only 25% in 48 patients who underwent GKS once for AVMs larger than 15 cm 3 ; the average margin doses were 17.7 Gy for AVMs with volumes of 10-20 cm 3 and 16.5 Gy for AVMs with volumes larger than 20 cm 3 . The authors also observed moderate adverse effects in 37% of patients and severe adverse effects in 12% of patients in whom AVM volumes were 10 cm 3 or larger.…”

Section: Discussionmentioning

confidence: 99%

“…tively as resection, can be achieved after a 2-to 3-year latency period for 80%-90% of small AVMs irradiated at the nidus margin with an optimal radiation dose. 1,4,[15][16][17]29,37 In such cases, the risk of radiation-related complications is acceptably low. 33,35 However, optimal radiation doses, considered necessary to obliterate the nidus completely with a single GKS session, cannot be delivered in some cases in which there are relatively large nidi.…”

mentioning

confidence: 99%

“…In such cases, nidus obliteration rates after a single GKS session are reportedly low. 6,7,12,18,21,23,37 In 1992, we began to treat some patients harboring AVMs with a volume greater than 10.0 cm 3 by using intentional 2-stage GKS with an interval of 3 years or more (dose-staging technique); preliminary results of this 2-stage procedure have been described in our previous publications. 32 To the best of our knowledge, although 2-stage (or occasionally, 3or even 4-stage) GKS performed using a volume-staging technique was reported by Sirin et al 27 and, most recently, by Kano et al 8 from the same institution, this is the first report to describe a dose-staging technique.…”

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confidence: 99%

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Long-term follow-up results of intentional 2-stage Gamma Knife surgery with an interval of at least 3 years for arteriovenous malformations larger than 10 cm3

Yamamoto

Akabane

Matsumaru

et al. 2012

JNS

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Object Little information is available on staged Gamma Knife surgery (GKS) with an interval of 3 years or more when used to treat arteriovenous malformations (AVMs) with volumes larger than 10 cm3. The goal of this study was to increase knowledge in this area by reporting the authors' experience. Methods The authors describe an institutional review board–approved retrospective study in which they examined databases including information on 250 patients who consecutively underwent GKS for cerebral AVMs during a 16-year period (1988–2004). Among the 250 patients the authors identified 31 patients (12.4%, 15 female and 16 male patients with a mean age of 29 years [range 10–63 years]) in whom 2-stage GKS was intentionally planned at the time of initial treatment because the volume of the AVM nidus was larger than 10 cm3. The most common presentation was bleeding (14 patients), followed by seizures (9 patients), incidental findings (7 patients), and headache with scintillation (1 patient). One patient underwent GKS for the treatment of 2 AVMs simultaneously, and thus 32 AVMs are included in this study. The mean nidus volume was 16.2 cm3 (maximum 55.8 cm3). In all 31 patients, relatively low radiation doses (12–16 Gy directed at the periphery of the lesion) were intentionally used for the first GKS. The second GKS was scheduled for at least 36 months after the first. Results Complete nidus obliteration was obtained after the first GKS in 1 patient. To date, 26 patients have undergone a second procedure with a post-GKS mean interval of 41 months (range 24–83 months); 2 other patients refused to undergo the second GKS, and no further treatment was given because of severe morbidity in 1 case and death due to bleeding in the other case. Among the 26 patients who did undergo a second procedure, 3 patients refused follow-up digital subtraction (DS) angiography, another is scheduled for follow-up DS angiography, and 2 patients died, one of bleeding and the other of an unknown cause. The remaining 20 patients underwent follow-up DS angiography. Complete nidus obliteration was confirmed in 13 patients (65.0%) and remarkable nidus shrinkage in the other 7 patients (35.0%). In 2 of these 7 patients, a third GKS achieved complete nidus obliteration. Therefore, the cumulative complete obliteration rate in this series was 76.2% (16 of 21 eligible patients). Seven patients (22.6%) experienced bleeding. The bleeding rates were 9.7%, 16.1%, 16.1%, and 26.1%, respectively, at 1, 2, 5, and 10 years post-GKS. There were 2 deaths and 3 cases of morbidity (persistent coma, mild hemimotor weakness, and hemianopsia in 1 patient each). Hemorrhage did not produce neurological deficits in the other 2 patients. During the mean post-GKS follow-up period of 105 months (range 42–229 months) to date, mild symptomatic GKS-related complications occurred in 2 patients (6.5%); these were classified as Radiation Oncology Group Neurotoxicity Grade 1 in 1 patient and Grade 2 in the other. Among various pre-GKS clinical factors, univariate analysis showed only patient age to impact complications (hazard ratio 0.675, 95% CI 0.306–0.942, p = 0.0085). The rate of complications in the pediatric cases was 33.3%, whereas that in the adolescent and adult cases was 0% (p = 0.0323). Conclusions Although a final conclusion awaits further studies and patient follow-up, these results suggest 2-stage GKS to be beneficial even for relatively large AVMs.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Long-term follow-up results of intentional 2-stage Gamma Knife surgery with an interval of at least 3 years for arteriovenous malformations larger than 10 cm3

Yamamoto

Akabane

Matsumaru

et al. 2012

JNS

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“…Se ha reconocido a esta modalidad como una de las opciones de tratamiento más efectiva y menos invasiva, que alcanza un intervalo de obliteración a los dos o tres años del procedimiento en el 60-89% de los casos [14,[19][20][21]; esto se correlaciona de forma inversamente proporcional con el volumen del nido, ya que se logra un 100% de obliteración en los menores de 1 cm 3 , 85% en los que tienen un volumen de 1-4 cm 3 y un 58% en los que tienen 4-10 cm 3 [22]. Colombo et al [23] también han estudiado esta relación, pero respecto al diámetro de la MAV, y encontraron un 96,5% de obliteración en las menores de 15 mm, 73,9% en las que su diámetro varió entre 15 y 25 mm, y 33,3% en las mayores de 25 mm.…”

Section: Radiocirugía Estereotácticaunclassified

Modalidades de tratamiento de las malformaciones arteriovenosas cerebrales

Fernández-Melo

López-Flores²,

Cruz-García³

et al. 2003

RevNeurol

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Introduction and development. Over the years new kinds of therapy have been incorporated into the treatment of arteriovenous malformations (AVM). Current treatment of AVM of the brain employs three well established options: radiosurgery, endovascular therapy (embolisation) and microsurgical resection. Radiosurgery is the simplest and least invasive, but 2-3 years are required to achieve total obliteration, and throughout this time there is the risk of bleeding; its use is limited to small AVM. Embolisation today plays a fundamental role more as an adjunct than when it is associated, although the other modes improve their cure interval by 25%. Microsurgery has the advantage of being the only mode of therapy that offers a degree of immediate angiographic obliteration of almost 100% and is still the most widely employed, despite its morbidity rate also being the highest. We establish an AVM management algorithm, in which, according to the size and localisation, we suggest that these therapeutic options should be used alone or in combination. Conclusions. The management of these lesions requires a combined effort of all the factors that can be of any help in the solution, and these modes are more complementary than competitive in situations in which they are all valid therapeutic options.

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“…If only those patients undergoing follow-up angiography are used as the denominator the obtained rate rises to 65%. 2 We stand by our methodology.…”

mentioning

confidence: 99%

Doppler Ultrasound in Subarachnoid Hemorrhage

1998

Journal of Neurosurgery

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Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformations

Cited by 3 publications

References 14 publications

Long-term follow-up results of intentional 2-stage Gamma Knife surgery with an interval of at least 3 years for arteriovenous malformations larger than 10 cm3

Long-term follow-up results of intentional 2-stage Gamma Knife surgery with an interval of at least 3 years for arteriovenous malformations larger than 10 cm3

Modalidades de tratamiento de las malformaciones arteriovenosas cerebrales

Doppler Ultrasound in Subarachnoid Hemorrhage

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