Abstract
We sought to define the long-term outcomes and risks of arteriovenous malformation (AVM) management using 2 or more stages of stereotactic radiosurgery (SRS) for symptomatic large-volume AVMs unsuitable for surgery. Two decades ago, we prospectively began to stage anatomical components in order to deliver higher single doses to AVMs >10 cm3 in volume. Forty-seven patients with large AVMs underwent volume-staged SRS. The median interval between the two SRS procedures was 4.9 months (range, 3-14 months). The median nidus volume was 11.5 cm3 (range, 4.0-26 cm3) in the first stage of SRS and 9.5 cm3 in the second. The median margin dose was 16 Gy (range, 13-18 Gy) for both SRS stages. The actuarial rates of total obliteration after 2-staged SRS were 7, 20, 28 and 36% at 3, 4, 5 and 10 years, respectively. Sixteen patients needed additional SRS at a median interval of 61 months (range, 33-113 months) after the 2-staged SRS. After repeat procedure(s), the eventual obliteration rate was 66% at 10 years. The cumulative rates of AVM hemorrhage after SRS were 4.3, 8.6, 13.5 and 36.0% at 1, 2, 5 and 10 years, respectively. Symptomatic adverse radiation effects were detected in 13% of patients. Successful prospective volume-staged SRS for large AVMs unsuitable for surgery requires 2 or more procedures to complete the obliteration process. Patients remain at risk for hemorrhage if the AVM persists.
| Original language | English |
|---|---|
| Title of host publication | Gamma Knife Radiosurgery for Brain Vascular Malformations |
| Publisher | S. Karger AG |
| Pages | 73-80 |
| Number of pages | 8 |
| Volume | 27 |
| ISBN (Electronic) | 9783805596206 |
| ISBN (Print) | 9783805596190 |
| DOIs | |
| Publication status | Published - 2012 Dec 12 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Medicine(all)
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Multistaged volumetric management of large arteriovenous malformations. / Kano, Hideyuki; Kondziolka, Douglas; Flickinger, John C.; Park, Kyung-Jae; Parry, Phillip V.; Yang, Huai che; Sirin, Sait; Niranjan, Ajay; Novotny, Josef; Lunsford, L. Dade.
Gamma Knife Radiosurgery for Brain Vascular Malformations. Vol. 27 S. Karger AG, 2012. p. 73-80.Research output: Chapter in Book/Report/Conference proceeding › Chapter
}
TY - CHAP
T1 - Multistaged volumetric management of large arteriovenous malformations
AU - Kano, Hideyuki
AU - Kondziolka, Douglas
AU - Flickinger, John C.
AU - Park, Kyung-Jae
AU - Parry, Phillip V.
AU - Yang, Huai che
AU - Sirin, Sait
AU - Niranjan, Ajay
AU - Novotny, Josef
AU - Lunsford, L. Dade
PY - 2012/12/12
Y1 - 2012/12/12
N2 - We sought to define the long-term outcomes and risks of arteriovenous malformation (AVM) management using 2 or more stages of stereotactic radiosurgery (SRS) for symptomatic large-volume AVMs unsuitable for surgery. Two decades ago, we prospectively began to stage anatomical components in order to deliver higher single doses to AVMs >10 cm3 in volume. Forty-seven patients with large AVMs underwent volume-staged SRS. The median interval between the two SRS procedures was 4.9 months (range, 3-14 months). The median nidus volume was 11.5 cm3 (range, 4.0-26 cm3) in the first stage of SRS and 9.5 cm3 in the second. The median margin dose was 16 Gy (range, 13-18 Gy) for both SRS stages. The actuarial rates of total obliteration after 2-staged SRS were 7, 20, 28 and 36% at 3, 4, 5 and 10 years, respectively. Sixteen patients needed additional SRS at a median interval of 61 months (range, 33-113 months) after the 2-staged SRS. After repeat procedure(s), the eventual obliteration rate was 66% at 10 years. The cumulative rates of AVM hemorrhage after SRS were 4.3, 8.6, 13.5 and 36.0% at 1, 2, 5 and 10 years, respectively. Symptomatic adverse radiation effects were detected in 13% of patients. Successful prospective volume-staged SRS for large AVMs unsuitable for surgery requires 2 or more procedures to complete the obliteration process. Patients remain at risk for hemorrhage if the AVM persists.
AB - We sought to define the long-term outcomes and risks of arteriovenous malformation (AVM) management using 2 or more stages of stereotactic radiosurgery (SRS) for symptomatic large-volume AVMs unsuitable for surgery. Two decades ago, we prospectively began to stage anatomical components in order to deliver higher single doses to AVMs >10 cm3 in volume. Forty-seven patients with large AVMs underwent volume-staged SRS. The median interval between the two SRS procedures was 4.9 months (range, 3-14 months). The median nidus volume was 11.5 cm3 (range, 4.0-26 cm3) in the first stage of SRS and 9.5 cm3 in the second. The median margin dose was 16 Gy (range, 13-18 Gy) for both SRS stages. The actuarial rates of total obliteration after 2-staged SRS were 7, 20, 28 and 36% at 3, 4, 5 and 10 years, respectively. Sixteen patients needed additional SRS at a median interval of 61 months (range, 33-113 months) after the 2-staged SRS. After repeat procedure(s), the eventual obliteration rate was 66% at 10 years. The cumulative rates of AVM hemorrhage after SRS were 4.3, 8.6, 13.5 and 36.0% at 1, 2, 5 and 10 years, respectively. Symptomatic adverse radiation effects were detected in 13% of patients. Successful prospective volume-staged SRS for large AVMs unsuitable for surgery requires 2 or more procedures to complete the obliteration process. Patients remain at risk for hemorrhage if the AVM persists.
UR - http://www.scopus.com/inward/record.url?scp=84958648032&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84958648032&partnerID=8YFLogxK
U2 - 10.1159/000341629
DO - 10.1159/000341629
M3 - Chapter
C2 - 23258511
AN - SCOPUS:84958648032
SN - 9783805596190
VL - 27
SP - 73
EP - 80
BT - Gamma Knife Radiosurgery for Brain Vascular Malformations
PB - S. Karger AG
ER -