scholarly journals Stereotactic Radiosurgery for Brain Arteriovenous Malformations

2018 ◽  
Vol 25 (3) ◽  
pp. 205-216
Author(s):  
Leonardo Frighetto ◽  
Timóteo Abrantes de Lacerda Almeida ◽  
Matheus Pintos Brunet ◽  
Pedro Radalle Biasi ◽  
Paulo Petry Oppitz ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Treatment Modalities ◽  
Benign Lesions ◽  
Modern Approach ◽  
Stereotactic Radiation ◽  
Brain Arteriovenous Malformations ◽  
Radiation Delivery ◽  
Technological Advances ◽  
Brain Avms

Stereotactic radiosurgery is an established treatment modality in the management of brain arteriovenous malformations (AVMs). Technological advances in radiation delivery systems associated with improvements in neuroimaging have recently changed radiosurgery indications and results. Besides this advances, and the association with microsurgery and embolization, the management of these benign lesions are still controversial. AVMs in eloquent areas and those with large volumes remain a challenge for all treatment modalities. This article discusses the modern approach of radiosurgery for brain AVMs including new options such as combined approaches and the use of hipofractionated stereotactic radiation for large and high flow lesions.

Endovascular Advances for Brain Arteriovenous Malformations

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S74-S82 ◽  
Author(s):  
R. Webster Crowley ◽  
Andrew F. Ducruet ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Endovascular Treatment ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Brain Arteriovenous Malformations ◽  
Short Period ◽  
Cerebral Avms ◽  
Brain Avms ◽  
The Brain ◽  
The Way

Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

Brain arteriovenous malformations

Neurology ◽  
2020 ◽  
Vol 95 (20) ◽  
pp. 917-927 ◽  
Author(s):  
Ching-Jen Chen ◽  
Dale Ding ◽  
Colin P. Derdeyn ◽  
Giuseppe Lanzino ◽  
Robert M. Friedlander ◽  
...  
Keyword(s):  
Natural History ◽  
Minimally Invasive ◽  
Arteriovenous Malformations ◽  
Cerebral Arteries ◽  
Treatment Strategies ◽  
Latency Period ◽  
Management Options ◽  
Brain Arteriovenous Malformations ◽  
Risk Of Hemorrhage ◽  
Brain Avms

Brain arteriovenous malformations (AVMs) are anomalous direct shunts between cerebral arteries and veins that convalesce into a vascular nidus. The treatment strategies for AVMs are challenging and variable. Intracranial hemorrhage and seizures comprise the most common presentations of AVMs. However, incidental AVMs are being diagnosed with increasing frequency due to widespread use of noninvasive neuroimaging. The balance between the estimated cumulative lifetime hemorrhage risk vs the risk of intervention is often the major determinant for treatment. Current management options include surgical resection, embolization, stereotactic radiosurgery (SRS), and observation. Complete nidal obliteration is the goal of AVM intervention. The risks and benefits of interventions vary and can be used in a combinatorial fashion. Resection of the AVM nidus affords high rates of immediate obliteration, but it is invasive and carries a moderate risk of neurologic morbidity. AVM embolization is minimally invasive, but cure can only be achieved in a minority of lesions. SRS is also minimally invasive and has little immediate morbidity, but AVM obliteration occurs in a delayed fashion, so the patient remains at risk of hemorrhage during the latency period. Whether obliteration can be achieved in unruptured AVMs with a lower risk of stroke or death compared with the natural history of AVMs remains controversial. Over the past 5 years, multicenter prospective and retrospective studies describing AVM natural history and treatment outcomes have been published. This review provides a contemporary and comprehensive discussion of the natural history, pathobiology, and interventions for brain AVMs.

RADIOSURGERY TO REDUCE THE RISK OF FIRST HEMORRHAGE FROM BRAIN ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 453-459 ◽  
Author(s):  
Keisuke Maruyama ◽  
Masahiro Shin ◽  
Masao Tago ◽  
Junji Kishimoto ◽  
Akio Morita ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Latency Period ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Brain Arteriovenous Malformations ◽  
Risk Of Hemorrhage ◽  
Observation Period

Abstract OBJECTIVE It remains unclear whether or not and to what extent stereotactic radiosurgery can reduce the risk of first intracranial hemorrhage from brain arteriovenous malformations. METHODS We performed a retrospective observational investigation of 500 patients with arteriovenous malformations who were treated with gamma knife radiosurgery. The risk of first hemorrhage was analyzed using the Cox proportional-hazards model with age at radiosurgery and angiographic obliteration included as time-dependent covariates. Three periods were defined: from birth to radiosurgery (before radiosurgery); from radiosurgery to angiographic obliteration (latency period); and from angiographic obliteration to end of the follow-up period (after obliteration). RESULTS Hemorrhage was documented before radiosurgery in 318 patients (median observation period, 30.0 yr), during the latency period in 11 patients (median observation period, 2.2 yr), and after obliteration in two patients (median observation period, 5.5 yr). Compared with the period before radiosurgery, the risk of hemorrhage decreased by 86% after obliteration (hazard ratio, 0.14; 95% confidence interval, 0.03–0.55; P = 0.005), whereas the reduction observed during the latency period was not statistically significant (hazard ratio, 0.56; 95% confidence interval, 0.31–1.04; P = 0.07). Irrespective of obliteration, the risk of hemorrhage decreased by 62% after radiosurgery (hazard ratio, 0.38; 95% confidence interval, 0.22–0.67; P = 0.001). Similar results were observed when the 33 patients who had undergone previous therapy were excluded from the analysis. CONCLUSION Stereotactic radiosurgery significantly reduces the risk of first hemorrhage from brain arteriovenous malformations. The extent of the decrease might be greater if angiography indicates the evidence of obliteration.

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