Microsurgical resection versus stereotactic radiosurgery for low-grade intracranial arteriovenous malformations: A 27-year institutional experience

2021 ◽  
Vol 94 ◽  
pp. 209-215
Author(s):  
Abhishek Gami ◽  
James Feghali ◽  
Sarah Rapaport ◽  
Shahab Aldin Sattari ◽  
Wuyang Yang ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Low Grade ◽  
Intracranial Arteriovenous Malformations ◽  
Institutional Experience ◽  
Microsurgical Resection

Radiosurgery as a microsurgical adjunct: outcomes after microsurgical resection of intracranial arteriovenous malformations previously treated with stereotactic radiosurgery

2021 ◽  
pp. 1-12
Author(s):  
Mark Bigder ◽  
Omar Choudhri ◽  
Mihir Gupta ◽  
Santosh Gummidipundi ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Perioperative Period ◽  
Low Grade ◽  
High Grade ◽  
Eligibility Criteria ◽  
Previously Treated ◽  
Microsurgical Resection ◽  
Cerebral Avms ◽  
Staged Treatment

OBJECTIVE Microsurgical resection of arteriovenous malformations (AVMs) can be aided by staged treatment consisting of stereotactic radiosurgery followed by resection in a delayed fashion. This approach is particularly useful for high Spetzler-Martin (SM) grade lesions because radiosurgery can reduce flow through the AVM, downgrade the SM rating, and induce histopathological changes that additively render the AVM more manageable for resection. The authors present their 28-year experience in managing AVMs with adjunctive radiosurgery followed by resection. METHODS The authors retrospectively reviewed records of patients treated for cerebral AVMs at their institution between January 1990 and August 2019. All patients who underwent stereotactic radiosurgery (with or without embolization), followed by resection, were included in the study. Of 1245 patients, 95 met the eligibility criteria. Univariate and multivariate regression analyses were performed to assess relationships between key variables and clinical outcomes. RESULTS The majority of lesions treated (53.9%) were high grade (SM grade IV–V), 31.5% were intermediate (SM grade III), and 16.6% were low grade (SM grade I–II). Hemorrhage was the initial presenting sign in half of all patients (49.5%). Complete resection was achieved among 84% of patients, whereas 16% had partial resection, the majority of whom received additional radiosurgery. Modified Rankin Scale (mRS) scores of 0–2 were achieved in 79.8% of patients, and 20.2% had poor (mRS scores 3–6) outcomes. Improved (44.8%) or stable (19%) mRS scores were observed among 63.8% of patients, whereas 36.2% had a decline in mRS scores. This includes 22 patients (23.4%) with AVM hemorrhage and 6 deaths (6.7%) outside the perioperative period but prior to AVM obliteration. CONCLUSIONS Stereotactic radiosurgery is a useful adjunct in the presurgical management of cerebral AVMs. Multimodal therapy allowed for high rates of AVM obliteration and acceptable morbidity rates, despite the predominance of high-grade lesions in this series of patients.

scholarly journals Microsurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery

1998 ◽  
Vol 38 (suppl) ◽  
pp. 200-207 ◽  
Author(s):  
Steven D. CHANG ◽  
Gary K. STEINBERG ◽  
Richard P. LEVY ◽  
Michael P. MARKS ◽  
Ken A. FRANKEL ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Microsurgical Resection

Repeat stereotactic radiosurgery for high-grade and large intracranial arteriovenous malformations

2007 ◽  
Vol 68 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Shaan M. Raza ◽  
Salma Jabbour ◽  
Quoc-Anh Thai ◽  
Gustavo Pradilla ◽  
Lawrence R. Kleinberg ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
High Grade ◽  
Intracranial Arteriovenous Malformations

Surgical Management Of Posterior Fossa Arteriovenous Malformations

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-189-ONS-201 ◽  
Author(s):  
John Sinclair ◽  
Michael E. Kelly ◽  
Gary K. Steinberg
Keyword(s):  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Cerebellar Nuclei ◽  
Preoperative Embolization ◽  
Frameless Stereotaxy ◽  
Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

Linear Accelerator Stereotactic Radiosurgery in the Management of Intracranial Arteriovenous Malformations: Long-Term Outcome

2014 ◽  
Vol 37 (5) ◽  
pp. 342-349 ◽  
Author(s):  
Yu-Chi Wang ◽  
Yin-Cheng Huang ◽  
Hsien-Chih Chen ◽  
Kuo-Cheng Wei ◽  
Cheng-Nen Chang ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Term Outcome ◽  
Long Term Outcome

Intracranial Masson Lesion Following Stereotactic Radiosurgery for Treatment of Intracranial Arteriovenous Malformations

2020 ◽  
Vol 141 ◽  
pp. 406-412
Author(s):  
Joy Roach ◽  
Alex Rossdeutsch ◽  
Mark Fabian ◽  
John Millar ◽  
Jonathan Duffill ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations

Results of a Conservative Dose Plan Linear Accelerator–Based Stereotactic Radiosurgery for Pediatric Intracranial Arteriovenous Malformations

2016 ◽  
Vol 95 ◽  
pp. 425-433 ◽  
Author(s):  
Vedantam Rajshekhar ◽  
Ranjith K. Moorthy ◽  
Visalakshi Jeyaseelan ◽  
Subhashini John ◽  
Faith Rangad ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations

scholarly journals Efficacy and Safety of Combined Endovascular Embolization and Stereotactic Radiosurgery for Patients with Intracranial Arteriovenous Malformations: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Zhiqun Jiang ◽  
Xuezhi Zhang ◽  
Xichen Wan ◽  
Minjun Wei ◽  
Yue Liu ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Meta Analysis ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Intracranial Arteriovenous Malformations ◽  
Obliteration Rate

Whether the use of endovascular embolization could provide additional benefits in patients treated with stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (IAVMs) remains controversial. The current meta-analysis was conducted to assess the efficacy and safety of SRS with and without prior endovascular embolization in patients with IAVMs. The electronic databases of PubMed, EmBase, and Cochrane Library were systematically searched for eligible studies published from inception to August 12, 2020. The pooled results for obliteration rate, rehemorrhage rate, and permanent neurological deficits were calculated by odds ratios (ORs) with 95% confidence intervals (CIs) using the random-effects model. The sensitivity analysis, subgroup analysis, and publication bias for investigated outcomes were also evaluated. Nineteen studies (two prospective and 17 retrospective studies) involving a total of 3,454 patients with IAVMs were selected for the final meta-analysis. We noted that prior embolization and SRS were associated with a lower obliteration rate compared with SRS alone (OR, 0.57; 95% CI, 0.44–0.74; P < 0.001 ). However, prior embolization and SRS were not associated with the risk of rehemorrhage (OR, 1.05; 95% CI, 0.81–1.34; P = 0.729 ) and permanent neurological deficits (OR, 0.80; 95% CI, 0.48–1.33; P = 0.385 ) compared with SRS alone. The sensitivity analysis suggested that prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs treated with SRS. The treatment effects of prior embolization in patients with IAVMs could be affected by nidus volume, margin dose, intervention, and follow-up duration. This study found that prior embolization was associated with a reduced risk of obliteration in patients with IAVMs treated with SRS. Moreover, prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs.

Sign in / Sign up

Export Citation Format

Share Document