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Gamma Knife for Cerebral Arteriovenous Malformations at a Single Centre

Published online by Cambridge University Press:  02 December 2014

F. A. Zeiler ,
P. J. McDonald ,
A. Kaufmann ,
D. Fewer ,
J. Butler ,
G. Schroeder  and
M. West
F. A. Zeiler*
Affiliation:
Department of Neurosurgery, Health Sciences Centre
P. J. McDonald
Affiliation:
Department of Neurosurgery, Health Sciences Centre
A. Kaufmann
Affiliation:
Department of Neurosurgery, Health Sciences Centre
D. Fewer
Affiliation:
Department of Neurosurgery, Health Sciences Centre
J. Butler
Affiliation:
Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
G. Schroeder
Affiliation:
Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
M. West
Affiliation:
Department of Neurosurgery, Health Sciences Centre
*
Department of Neurosurgery, Health Sciences Center, University of Manitoba, GB-134, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada.
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Abstract

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Background:

We report the results of a consecutive series of patients treated with Gamma Knife (GK) Surgery for cerebral arteriovenous malformations (AVMs).

Methods:

We retrospectively reviewed 69 patients treated with GK for cerebral AVMs between November 2003 and April 2009, recording clinical data, treatment parameters, and AVM obliteration rates in order to assess our effectiveness with GK in treating these lesions.

Results:

Ten patients were lost to follow-up. Presentations included: seizure (24), hemorrhage (18), persistent headache (12), progressing neurological signs (10), and incidental (9). In 24 patients (34.8%) treatment planning consisted of digital subtraction angiography (DSA), magnetic resonance imaging (MRI), and computed tomogram (CT) angiography (CTA). Currently we rely predominantly on CTA and/or MRI scanning only. Fourty-one patients have been followed for a minimum of 3 years; average age 40.9yr., 58.5% males. Average dose at the 50% isodose line was 20.3 Gy (range 16 to 26.4 Gy). Obliteration was observed in 87.8% by MRI, CT, or DSA. Not all obliteration was confirmed by DSA. Complications occurred in 12 of 59 (20.3%) patients, and in 11 of 41 (26.8%) with 3 year follow-up. Major (temporary) complications for the 59 included symptomatic cerebral edema (7), seizure (2), and hemorrhage (1). Major permanent complications occurred in one patient suffering a cranial nerve V deafferentation, and in two patients suffering a hemorrhage.

Conclusion:

GKS for cerebral AVM's offers an effective and safe method of treatment, with low permanent complication rate.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 6 , November 2011 , pp. 851 - 857
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1.Starke, RM, Komotar, RJ, Hwang, BY, et al.Acomprehensive review of radiosurgery for cerebral arteriovenous malformations: outcomes, predictive factors, and grading scales. Stereotact Funct Neurosurg. 2008; 86: 191–9.Google Scholar
2.Andrade-Souza, YM, Ramani, M, Scora, D, et al.Embolization before radiosurgery reduces the obliteration rate of arteriovenous malformations. Neurosurgery. 2007; 60: 443–52.Google Scholar
3.Andrade-Souza, YM, Ramani, M, Scora, D, et al.Radiosurgical treatment for rolandic arteriovenous malformations. J Neurosurg. 2006;105:689–97.Google Scholar
4.Andrade-Souza, YM, Zadeh, G, Scora, D, et al.Radiosurgery for basal ganglia, internal capsule, and thalamus arteriovenous malformation: clinical outcome. Neurosurgery. 2005; 56: 56–63.Google Scholar
5.Back, AG, Vollmer, D, Zeck, O, et al.Retrospective analysis of unstaged and staged Gamma Knife surgery with and without preceding embolization for the treatment of arteriovenous malformations. J Neurosurg. 2008; 109(Suppl): 57–64.Google Scholar
6.Douglas, JG, Goodkin, R.Treatment of arteriovenous malformations using gamma knife surery: the experience at the University of Washington fromm 2000 to 2005. J Neurosurg. 2008; 109: 51–6.Google Scholar
7.Flickinger, JC, Kondziolka, D, Lunsford, LD, et al.Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Int J Radiat Oncol Biol Phys. 2000; 46: 1143–8.Google Scholar
8.Flickinger, JC, Kondziolka, D, Maitz, AH, et al.An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiother Oncol. 2002; 63: 347–54.Google Scholar
9.Flickinger, JC, Pollock, BE, Kondziolka, D, et al.A dose-response analysis of arteriovenous malformation obliteration after radiosurgery. Int J Radiat Oncol Biol Phys. 1996; 36:873–9.Google Scholar
10.Hadjipanayis, CG, Levy, EI, Niranjan, A, et al.Stereotactic radiosurgery for motor cortex region arteriovenous malformations. Neurosurgery. 2001; 48: 70–6.Google Scholar
11.Liscák, R, Vladyka, V, Simonová, G, et al.Arteriovenous malformations after Leksell gamma knife radiosurgery: rate of obliteration and complications. Neurosurgery. 2007; 60: 1005–14.CrossRefGoogle ScholarPubMed
12.Maruyama, K, Shin, M, Tago, M, et al.Gamma knife surgery for arteriovenous malformations involving the corpus callosum. Neurosurgery. 2005; 102(Suppl): 49–52.Google Scholar
13.Pollock, BE, Gorman, DA, Brown, PD.Radiosurgery for arteriovenous malformations of the basal ganglia, thalamus, and brainstem. J Neurosurg. 2004; 100: 210–4.Google Scholar
14.Shin, M, Maruyama, K, Kurita, H.Analysis of nidus obliteration rates after gamma knife radiosurgery for arteriovenous malformations based on long-term follow up data: the University of Tokyo experience. J Neurosurg. 2004; 101: 18–24.CrossRefGoogle ScholarPubMed
15.Young, C, Summerfield, R, Schwartz, ML, et al.Radiosurgery for arteriovenous malformations: the University of Toronto experience. Can J Neurol Sci. 1997; 24(2): 99–105.Google Scholar
16.Zadeh, G, Andrade-Souza, YM, Tsao, MN, et al.Pediatric arteriovenous malformations: University of Toronto experience using sterotactic radiosurgery. Childs Nerv Syst. 2007; 23: 195–9.Google Scholar
17.Pollock, BE, Flickinger, JC.A proposed radiosurgery-based grading system for arteriovenous malformations. J Neurosurg. 2002; 96: 70–85.Google Scholar
18.Pollock, BE, Flickinger, JC.Modification of the radiosurgery-based arteriovenous malformation grading system. Neurosurgery. 2008; 63: 239–43.Google Scholar
19.Pollock, BE, Kondziolka, D, Flickinger, JC, et al.Magnetic resonance imaging: an accurate method to evaluate artiovenous malformations after stereotactic radiosurgery. J Neurosurg. 1996; 85: 1044–9.Google Scholar
20.Spetzler, RF, Martin, NA.A proposed grading system for arteriovenous malformations. J Neurosurg. 1986; 65: 476–83.CrossRefGoogle ScholarPubMed
21.Schauble, D, Cascino, GD, Pollock, BE, et al.Seizure outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations. Neurology. 2004; 63: 683–7.CrossRefGoogle ScholarPubMed
22.Yen, CP, Varady, P, Sheehan, J.Subtotal obliteration of cerebral arteriovenous malformations after gamma knife surgery. J Neurosurg. 2007; 106: 361–9.Google Scholar
23.Pollock, BE, Flickinger, JC, Lunsford, LD.Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery. 1996; 38: 652–9.CrossRefGoogle ScholarPubMed
24.Mirza-Aghazadeh, J, Andrande-Souza, YM, Zadeh, G, et al.Radiosurgical retreatment for brain arteriovenous malformation. Can J Neurol Sci. 2006; 33: 189–94.Google Scholar