Multistaged volumetric management of large arteriovenous malformations

Hideyuki Kano; Douglas Kondziolka; John C. Flickinger; Kyung Jae Park; Phillip V. Parry; Huai Che Yang; Sait Sirin; Ajay Niranjan; Josef Novotny; L. Dade Lunsford

doi:10.1159/000341629

Multistaged volumetric management of large arteriovenous malformations

Hideyuki Kano, Douglas Kondziolka, John C. Flickinger, Kyung Jae Park, Phillip V. Parry, Huai Che Yang, Sait Sirin, Ajay Niranjan, Josef Novotny, L. Dade Lunsford

Research output: Chapter in Book/Report/Conference proceeding › Chapter

13 Citations (Scopus)

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
Editors	Ajay Niranjan, Hideyuki Kano, Dade Lunsford
Pages	73-80
Number of pages	8
DOIs	https://doi.org/10.1159/000341629
Publication status	Published - 2013
Externally published	Yes

Publication series

Name	Progress in Neurological Surgery
Volume	27
ISSN (Print)	0079-6492
ISSN (Electronic)	1662-3924

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1159/000341629

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Kano, H., Kondziolka, D., Flickinger, J. C., Park, K. J., Parry, P. V., Yang, H. C., Sirin, S., Niranjan, A., Novotny, J., & Lunsford, L. D. (2013). Multistaged volumetric management of large arteriovenous malformations. In A. Niranjan, H. Kano, & D. Lunsford (Eds.), Gamma Knife Radiosurgery for Brain Vascular Malformations (pp. 73-80). (Progress in Neurological Surgery; Vol. 27). https://doi.org/10.1159/000341629

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. ed. / Ajay Niranjan; Hideyuki Kano; Dade Lunsford. 2013. p. 73-80 (Progress in Neurological Surgery; Vol. 27).

Research output: Chapter in Book/Report/Conference proceeding › Chapter

Kano, H, Kondziolka, D, Flickinger, JC, Park, KJ, Parry, PV, Yang, HC, Sirin, S, Niranjan, A, Novotny, J & Lunsford, LD 2013, Multistaged volumetric management of large arteriovenous malformations. in A Niranjan, H Kano & D Lunsford (eds), Gamma Knife Radiosurgery for Brain Vascular Malformations. Progress in Neurological Surgery, vol. 27, pp. 73-80. https://doi.org/10.1159/000341629

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. / Multistaged volumetric management of large arteriovenous malformations. Gamma Knife Radiosurgery for Brain Vascular Malformations. editor / Ajay Niranjan ; Hideyuki Kano ; Dade Lunsford. 2013. pp. 73-80 (Progress in Neurological Surgery).

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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.",

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ER -

Multistaged volumetric management of large arteriovenous malformations

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