Bevacizumab used for the treatment of severe, refractory perilesional edema due to an arteriovenous malformation treated with stereotactic radiosurgery

The authors present a case of an arteriovenous malformation of the central sulcus treated with Gamma Knife surgery. The patient developed perilesional edema 9 months after treatment and experienced severe headache and hemiparesis. Her symptoms were refractory to corticosteroid therapy and pain management. She was subsequently treated with bevacizumab with striking improvement in her symptoms and results of neuroimaging studies. This is the first time that bevacizumab has been used to control severe refractory perilesional edema related to an intracranial arteriovenous malformation.

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Late recovery of stereotactic radiosurgery induced perilesional edema of an arteriovenous malformation after bevacizumab treatment

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1742294 ◽

2020 ◽

pp. 1-5

Author(s):

Ece Uysal ◽

Ozan Başkurt ◽

İdris Avcı ◽

Halil Olgun Peker ◽

Suat Erol Çelik

Keyword(s):

Arteriovenous Malformation ◽

Stereotactic Radiosurgery ◽

Perilesional Edema ◽

Bevacizumab Treatment ◽

Late Recovery

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Stereotactic irradiation for intracranial arteriovenous malformation using stereotactic radiosurgery or hypofractionated stereotactic radiotherapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.04.041 ◽

2004 ◽

Vol 60 (3) ◽

pp. 861-870 ◽

Cited By ~ 50

Author(s):

Ta-Chen Chang ◽

Hiroki Shirato ◽

Hidefumi Aoyama ◽

Satoshi Ushikoshi ◽

Norio Kato ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Stereotactic Radiosurgery ◽

Stereotactic Radiotherapy ◽

Stereotactic Irradiation ◽

Intracranial Arteriovenous Malformation ◽

Hypofractionated Stereotactic Radiotherapy

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Chronic encapsulated expanding hematoma after gamma knife stereotactic radiosurgery for cerebral arteriovenous malformation

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2011.03.010 ◽

2011 ◽

Vol 113 (8) ◽

pp. 668-671 ◽

Cited By ~ 13

Author(s):

Cheng-Chia Lee ◽

David Hung-Chi Pan ◽

Donald Ming-Tak Ho ◽

Hsin-Mei Wu ◽

Wen-Yuh Chung ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Cerebral Arteriovenous Malformation ◽

Gamma Knife Stereotactic Radiosurgery

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Management of a complex intracranial arteriovenous malformation with gamma knife radiosurgery: A case report with review of literature

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2017.10.056 ◽

2018 ◽

Vol 49 ◽

pp. 26-31 ◽

Cited By ~ 1

Author(s):

Shyamal C. Bir ◽

Subhas K. Konar ◽

Devi P. Patra ◽

Tanmoy K. Maiti ◽

Alireza Minagar ◽

...

Keyword(s):

Case Report ◽

Arteriovenous Malformation ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Review Of Literature ◽

Intracranial Arteriovenous Malformation

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The predictive value of magnetic resonance imaging in evaluating intracranial arteriovenous malformation obliteration after stereotactic radiosurgery

Journal of Neurosurgery ◽

10.3171/2014.10.jns141565 ◽

2015 ◽

Vol 123 (1) ◽

pp. 136-144 ◽

Cited By ~ 36

Author(s):

Cheng-Chia Lee ◽

Michael A. Reardon ◽

Benjamin Z. Ball ◽

Ching-Jen Chen ◽

Chun-Po Yen ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Stereotactic Radiosurgery ◽

Predictive Value ◽

False Negative ◽

Consecutive Series ◽

Intracranial Arteriovenous Malformation ◽

Complete Obliteration ◽

Sensitivity Specificity ◽

The University

OBJECT The current gold standard for diagnosing arteriovenous malformation (AVM) and assessing its obliteration after stereotactic radiosurgery (SRS) is digital subtraction angiography (DSA). Recently, MRI and MR angiography (MRA) have become increasingly popular imaging modalities for the follow-up of patients with an AVM because of their convenient setup and noninvasiveness. In this study, the authors assessed the sensitivity and specificity of MRI/MRA in evaluating AVM nidus obliteration as assessed by DSA. METHODS The authors study a consecutive series of 136 patients who underwent SRS between January 2000 and December 2012 and who underwent regular clinical examinations, several MRI studies, and at least 1 post-SRS DSA follow- up evaluation at the University of Virginia. The average follow-up time was 47.3 months (range 10.1–165.2 months). Two blinded observers were enrolled to interpret the results of MRI/MRA compared with those of DSA. The sensitivity, specificity, positive predictive value, and negative predictive value for the obliteration of AVM were reported. RESULTS On the basis of DSA, 73 patients (53.7%) achieved final angiographic obliteration in a median of 28.8 months. The sensitivity (the probability of finding obliteration on MRI/MRA among those for whom complete obliteration was shown on DSA) was 84.9% for one observer (Observer 1) and 76.7% for the other (Observer 2). The specificity was 88.9% and 95.2%, respectively. The false-negative interpretations were significantly related to the presence of draining veins, perinidal edema on T2-weighted images, and the interval between the MRI/MRA and DSA studies. CONCLUSIONS MRI/MRA predicted AVM obliteration after SRS in most patients and can be used in their follow-up. However, because the specificity of MRI/MRA is not perfect, DSA should still be performed to confirm AVM nidus obliteration after SRS.

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