scholarly journals Recurrent Arteriovenous Malformation after Gamma Knife Radiosurgery: Recurrence or New Nidus Formation after Complete Obliteration

2018 ◽  
Vol 46 (4) ◽  
pp. 268-274
Author(s):  
Hiroyuki KENAI ◽  
Masanori YAMASHITA ◽  
Yuzo HORI ◽  
Akira YAMADA ◽  
Tomoshige ASANO ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Complete Obliteration

scholarly journals Endovascular Treatment Accounts for a Change in Brain Arteriovenous Malformation Natural History Risk

2010 ◽  
Vol 16 (2) ◽  
pp. 127-132 ◽  
Author(s):  
X. Lv ◽  
Z. Wu ◽  
C. Jiang ◽  
Y. Li ◽  
X. Yang ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Adjusted Relative Risk ◽  
Brain Arteriovenous Malformation ◽  
Kaplan Meier ◽  
Complete Obliteration ◽  
Risk Of Hemorrhage

This study estimated the risk and rates of intracranial hemorrhage (ICH) in patients harboring brain arteriovenous malformation (BAVM) after endovascular embolization. One hundred and forty-four consecutive patients with BAVM treated with endovascular embolization between 1998 and 2003 were retrospectively reviewed. The risk of ICH subsequent to endovascular embolization was studied using Kaplan-Meier curves. We reviewed 144 patients with BAVM treated with endovascular embolization. Two hundred and sixty-nine procedures were performed, 69 were performed with silk sutures, 18 with coils, 137 with NBCA and 36 with Onyx18. Twenty-three (16.0%) patients were treated with additional gamma-knife radiosurgery and one (0.7%) with additional surgical AVM excision. Complete obliteration of BAVMs was achieved in 20 patients (13.9%). During a mean follow-up of 5.9 years for the ICH group and 6.9 years for the non-ICH group, hemorrhages occurred in 11 (17.7%) of the ICH patients and in nine (11%) of the non-ICH group (p>0.1). The annual risk of hemorrhage was 3.0% and 1.6%, respectively. In the multivariate regression model, the adjusted relative risk (RR) for hemorrhage at initial presentation was 1.6 (95% CI 1.2–3.2; p>0.1). Deep venous drainage, male sex, age or AVM size were not significantly associated with subsequent hemorrhage. ICH and non-ICH groups did not differ in progression to subsequent ICH after endovascular embolization (log-rank X2 = 1.339, p>0.1) in survival analyses. The overall annual hemorrhage risk for all patients after endovascular embolization was 2.1%. Endovascular embolization alone or combined with gamma-knife radiosurgery or surgical treatment are able to decrease ICH occurrence compared to abstention.

scholarly journals Gamma Knife Radiosurgery Followed by Flow-Reductive Embolization for Ruptured Arteriovenous Malformation

2020 ◽  
Vol 9 (5) ◽  
pp. 1318
Author(s):  
Myung Ji Kim ◽  
So Hee Park ◽  
Keun Young Park ◽  
Hyun Ho Jung ◽  
Jong Hee Chang ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Predictive Factors ◽  
Gamma Knife Radiosurgery ◽  
Latency Period ◽  
Cyst Formation ◽  
Complication Rates ◽  
Major Drawback ◽  
Significant Difference ◽  
Complete Obliteration

Background: Aggressive treatment to achieve complete obliteration of brain arteriovenous malformation (AVM) is necessary in patients with a recent history of hemorrhage. The major drawback of Gamma knife radiosurgery (GKRS) alone for AVM is risk of bleeding during the latent period until the AVM occludes. At our center, patients who present with ruptured AVMs are frequently offered GKRS followed by embolization. The goal of this study was to compare outcomes of embolization for patients who have previously undergone GKRS for ruptured AVMs. Methods: A database including 150 GKRS for ruptured AVMs between November 2008 and October 2017 was reviewed. The embolized group was selected by including AVMs with post-GKRS embolization. The non-embolized group was defined as AVMs treated by GKRS alone. Outcomes including obliteration rate, incidence of repeat hemorrhage, and delayed cyst formation were compared between two groups. The predictive factors related to AVM obliteration and complications were analyzed. Results: The study consisted of 81 patients in the non-embolized group and 17 patients in the embolized group. Statistically significant differences were detected between the two groups with respect to age, Pollock-Flickinger score, Spetzler-Martin (SM) grade, eloquence of adjacent brain, and presence of aneurysms. The embolized group included more AVMs with larger median nidus volume. The predictive factors for the obliteration of ruptured AVMs were nidus volume, SM grade, Virginia Radiosurgery AVM Scale (VRAS), and Pollock-Flickinger score and for the subsequent hemorrhage were marginal dose, nidus volume, SM grade, VRAS, and Pollock-Flickinger score. The obliteration rates and complication rates after GKRS between groups were not significantly different. However, this study demonstrated statistically significant difference in the cumulative incidence of obliteration in AVMs with SM grade III and IV (p = 0.037). Conclusion: Although the current study demonstrated similar results in patients who underwent GKRS with and without embolization, the embolized group included more AVMs with larger nidus volume, higher SM grade, Pollock-Flickinger score, and aneurysm, which have a lower chance of obliteration and a higher probability of repeat hemorrhage. GKRS followed by embolization appears to be a beneficial approach for the treatment of ruptured AVMs that are at risk for obliteration failure and repeat hemorrhage during the latency period after single-session GKRS alone. Further studies involving a larger number of cases and continuous follow-up are necessary to confirm our conclusions.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

scholarly journals Bibliometric analysis of the top-100 most cited articles on the radiosurgical management of cerebral arteriovenous malformation

2020 ◽  
Vol 11 ◽  
pp. 477
Author(s):  
Ali Alkhabiry ◽  
Othman T. Almutairi ◽  
Turki Elarjani ◽  
Mohammed Bafaquh ◽  
Hossam Alassaf ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
The United States ◽  
Cerebral Arteriovenous Malformations ◽  
Exclusion Criteria ◽  
Scholarly Impact ◽  
English Articles ◽  
Conference Papers ◽  
Specific Search

Background: Radiosurgery is an effective, alternative treatment modality in managing patients with cerebral arteriovenous malformations (AVMs). The present study aims to highlight the scholarly impact of the top-100 most cited articles on the radiosurgical management of AVMs. Methods: A title-specific search using the keyword “arteriovenous malformation” was conducted in the Scopus database. The outcome of the search was rearranged based on the citations count. Articles were categorized into four entities; clinical, gamma knife radiosurgery, linear accelerator (LINAC) radiosurgery, and proton beam radiosurgery. The exclusion criteria were applied to spinal or non-intracranial AVM, conference papers, non-English articles predominantly discussing the endovascular or microsurgical management. Results: The top-100 articles on the radiosurgical management of AVM were published between 1972 and 2016. Approximately one-third of the publications were produced between 1995 and 2000. The average citations per year for all papers were seven. The most-studied entity was pertinent to the clinical application of gamma knife radiosurgery in AVM (68%). The United States was the most active country in studying the radiosurgical application in AVM. The Journal of Neurosurgery published approximately one-third of the most-cited articles in the list. The top-3 most contributing authors, publishing 80% of articles in the list, were Lunsford et al. Conclusion: The radiosurgical management of AVMs evolved significantly throughout the years. Identifications of the publication trends facilitate the acquisition of evidence-based articles for authors investigating various radiosurgical techniques in the treatment of AVMs.

scholarly journals A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

2015 ◽  
Vol 123 (4) ◽  
pp. 945-953 ◽  
Author(s):  
Or Cohen-Inbar ◽  
Cheng-Chia Lee ◽  
Zhiyuan Xu ◽  
David Schlesinger ◽  
Jason P. Sheehan
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Effects ◽  
Late Onset ◽  
Gamma Knife Radiosurgery ◽  
Volumetric Analysis ◽  
Institutional Review ◽  
Complete Obliteration ◽  
Quantitative Changes

OBJECT The authors review outcomes following Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVMs) and their correlation to postradiosurgery adverse radiation effects (AREs). METHODS From a prospective institutional review board–approved database, the authors identified patients with a minimum of 2 years of follow-up and thin-slice T2-weighted MRI sequences for volumetric analysis. A total of 105 AVM patients were included. The authors analyzed the incidence and quantitative changes in AREs as a function of time after GKRS. Statistical analysis was performed to identify factors related to ARE development and changes in the ARE index. RESULTS The median clinical follow-up was 53.8 months (range 24–212.4 months), and the median MRI follow-up was 36.8 months (range 24–212.4 months). 47.6% of patients had an AVM with a Spetzler-Martin grade ≥ III. The median administered margin and maximum doses were 22 and 40 Gy, respectively. The overall obliteration rate was 70.5%. Of patients who showed complete obliteration, 74.4% developed AREs within 4–6 months after GKRS. Late-onset AREs (i.e., > 12 months) correlated to a failure to obliterate the nidus. 58.1% of patients who developed appreciable AREs (defined as ARE index > 8) proceeded to have a complete nidus obliteration. Appreciable AREs were found to be influenced by AVM nidus volume > 3 ml, lobar location, number of draining veins and feeding arteries, prior embolization, and higher margin dose. On the other hand, a minimum ARE index > 8 predicted obliteration (p = 0.043). CONCLUSIONS ARE development after radiosurgery follows a temporal pattern peaking at 7–12 months after stereotactic radiosurgery. The ARE index serves as an important adjunct tool in patient follow-up and outcome prediction.

Fatal glioblastoma after Gamma Knife radiosurgery for arteriovenous malformation in a child

2014 ◽  
Vol 21 (8) ◽  
pp. 1453-1455 ◽  
Author(s):  
Koichi Yoshida ◽  
Tomotsugu Ichikawa ◽  
Kazuhiko Kurozumi ◽  
Hiroyuki Yanai ◽  
Keisuke Onoda ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery

Long-term Effects of Gamma-knife Radiosurgery for Cerebral Arteriovenous Malformation

2008 ◽  
Vol 18 (2) ◽  
pp. 126-129
Author(s):  
Gang Zhao ◽  
Jun-chao Liang ◽  
Wei-min Wang ◽  
Hong-xun Wu ◽  
Lin Li ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Cerebral Arteriovenous Malformation ◽  
Long Term Effects

The Role of Gamma Knife Radiosurgery in Arteriovenous Malformation with Aneurysms

1999 ◽  
Vol 72 (1) ◽  
pp. 175-184 ◽  
Author(s):  
J. Vymazal ◽  
R. Liščagrave;k ◽  
J. Novotný ◽  
L. Janoušková ◽  
V. Vladyka
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery

scholarly journals Three Case Reports of Direct Surgery for Angiomatous Lesion Developing after Gamma Knife Radiosurgery for Arteriovenous Malformation

2011 ◽  
Vol 39 (5) ◽  
pp. 347-352 ◽  
Author(s):  
Takashi SHUTO ◽  
Shigeo MATSUNAGA ◽  
Jun SUENAGA ◽  
Tetsuya YOSHIZUMI ◽  
Shigeo INOMORI ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Case Reports ◽  
Gamma Knife Radiosurgery
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