Long-term complications after gamma knife surgery for arteriovenous malformations

View More View Less
  • 1 Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object. The authors analyzed of the long-term complications that occur 2 or more years after gamma knife surgery (GKS) for intracranial arteriovenous malformations (AVMs).

Methods. Patients with previously untreated intracranial AVMs that were managed by GKS and followed for at least 2 years after treatment were selected for analysis (237 cases). Complete AVM obliteration was attained in 130 cases (54.9%), and incomplete obliteration in 107 cases (45.1%). Long-term complications were observed in 22 patients (9.3%). These complications included hemorrhage (eight cases), delayed cyst formation (eight cases), increase of seizure frequency (four cases), and middle cerebral artery stenosis and increased white matter signal intensity on T2-weighted magnetic resonance imaging (one case of each). The long-term complications were associated with larger nidus volume (p < 0.001) and a lobar location of the AVM (p < 0.01). Delayed hemorrhage was associated only with incomplete obliteration of the nidus (p < 0.05). Partial obliteration conveyed no benefit. Delayed cyst formation was associated with a higher maximal GKS dose (p < 0.001), larger nidus volume (p < 0.001), complete nidus obliteration (p < 0.01), and a lobar location of the AVM (p < 0.05).

Conclusions. Incomplete obliteration of the nidus is the most important factor associated with delayed hemorrhagic complications. Partial obliteration does not seem to reduce the risk of hemorrhage. Complete obliteration can be complicated by delayed cyst formation, especially if high maximal treatment doses have been administered.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Colombo F, , Pozza F, & Chierego G, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations an update clinical study. Neurosurgery 34:1421, 1994 Colombo F, Pozza F, Chierego G, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations an update clinical study. Neurosurgery 34:14–21, 1994

    • Search Google Scholar
    • Export Citation
  • 2.

    Ellis TL, , Friedman WA, & Bova FJ, et al: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104110, 1998 Ellis TL, Friedman WA, Bova FJ, et al: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104–110, 1998

    • Search Google Scholar
    • Export Citation
  • 3.

    Flickinger JC, , Kondziolka D, & Lunsford LD, et al: A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 44:6774, 1999 Flickinger JC, Kondziolka D, Lunsford LD, et al: A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 44:67–74, 1999

    • Search Google Scholar
    • Export Citation
  • 4.

    Friedman WA: Radiosurgery for arteriovenous malformations in Kondziolka D (ed): Radiosurgery Vol 4. Basel: Karger, 2002, pp 1218 Friedman WA: Radiosurgery for arteriovenous malformations in Kondziolka D (ed): Radiosurgery Vol 4. Basel: Karger, 2002, pp 12–18

    • Search Google Scholar
    • Export Citation
  • 5.

    Inoue HK, , Tezuka M, & Oda O, et al: Optimal radiosurgery dosages for the treatment of arteriovenous malformations in the era of magnetic resonance imaging in Kondziolka D (ed): Radiosurgery Vol 4. Basel Karger, 2002, pp 1925 Inoue HK, Tezuka M, Oda O, et al: Optimal radiosurgery dosages for the treatment of arteriovenous malformations in the era of magnetic resonance imaging in Kondziolka D (ed): Radiosurgery Vol 4. Basel Karger, 2002, pp 19–25

    • Search Google Scholar
    • Export Citation
  • 6.

    Karlsson B, , Lax I, & Soderman M: Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 49:10451051, 2001 Karlsson B, Lax I, Soderman M: Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 49:1045–1051, 2001

    • Search Google Scholar
    • Export Citation
  • 7.

    Kihlstrom L, , Guo WY, & Karlsson B, et al: Magnetic resonance imaging of obliterated arteriovenous malformations up to 23 years after radiosurgery. J Neurosurg 86:589593, 1997 Kihlstrom L, Guo WY, Karlsson B, et al: Magnetic resonance imaging of obliterated arteriovenous malformations up to 23 years after radiosurgery. J Neurosurg 86:589–593, 1997

    • Search Google Scholar
    • Export Citation
  • 8.

    Pollock BE, , Kline RW, & Stafford SL, et al: The rationale and technique of staged-volume arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 48:817824, 2000 Pollock BE, Kline RW, Stafford SL, et al: The rationale and technique of staged-volume arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 48:817–824, 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Steiner L, , Leksell L, & Greitz T, et al: Stereotaxic radiosurgery for cerebral arteriovenous malformations report of a case. Acta Chir Scand 138:459464, 1972 Steiner L, Leksell L, Greitz T, et al: Stereotaxic radiosurgery for cerebral arteriovenous malformations report of a case. Acta Chir Scand 138:459–464, 1972

    • Search Google Scholar
    • Export Citation
  • 10.

    Szeifert GT, , Vandersmissen B, & Taib NOB, et al: Recurrent hemorrhage in a radiosurgically obliterated cerebral arteriovenous malformation in Kondziolka D (ed): Radiosurgery Vol 4. Basel:Karger, 2002, pp 3441 Szeifert GT, Vandersmissen B, Taib NOB, et al: Recurrent hemorrhage in a radiosurgically obliterated cerebral arteriovenous malformation in Kondziolka D (ed): Radiosurgery Vol 4. Basel: Karger, 2002, pp 34–41

    • Search Google Scholar
    • Export Citation
  • 11.

    Yamamoto M, , Hara M, & Ide M, et al: Radiation-related adverse effects observed on neuro-imaging several years after radiosurgery for cerebral arteriovenous malformations. Surg Neurol 49:385398, 1998 Yamamoto M, Hara M, Ide M, et al: Radiation-related adverse effects observed on neuro-imaging several years after radiosurgery for cerebral arteriovenous malformations. Surg Neurol 49:385–398, 1998

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 580 169 1
Full Text Views 138 23 0
PDF Downloads 86 24 0
EPUB Downloads 0 0 0