@inbook{11cbd4dcd5bc48068d35cd43f668bc05,
title = "Multistaged volumetric management of large arteriovenous malformations",
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.",
author = "Hideyuki Kano and Douglas Kondziolka and Flickinger, {John C.} and Park, {Kyung Jae} and Parry, {Phillip V.} and Yang, {Huai Che} and Sait Sirin and Ajay Niranjan and Josef Novotny and Lunsford, {L. Dade}",
year = "2013",
doi = "10.1159/000341629",
language = "English",
isbn = "9783805596190",
series = "Progress in Neurological Surgery",
pages = "73--80",
editor = "Ajay Niranjan and Hideyuki Kano and Dade Lunsford",
booktitle = "Gamma Knife Radiosurgery for Brain Vascular Malformations",
}