Long-term complications after gamma knife surgery for arteriovenous malformations

Masahiro IzawaDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Motohiro HayashiDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Mikhail ChernovDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Koutarou NakayaDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Taku OchiaiDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Noriko MurataDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Yuichi TakasuDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Osami KuboDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Tomokatsu HoriDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Kintomo TakakuraDepartment of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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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.

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  • 1.

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