Stereotactic radiosurgery for arteriovenous malformations of the brain

L. Dade Lunsford Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by L. Dade Lunsford in
Current site
Google Scholar
PubMed Close
 M.D.
,
Douglas Kondziolka Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by Douglas Kondziolka in
Current site
Google Scholar
PubMed Close
 M.D.
,
John C. Flickinger Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by John C. Flickinger in
Current site
Google Scholar
PubMed Close
 M.D.
,
David J. Bissonette Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by David J. Bissonette in
Current site
Google Scholar
PubMed Close
 PA-C
,
Charles A. Jungreis Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by Charles A. Jungreis in
Current site
Google Scholar
PubMed Close
 M.D.
,
Ann H. Maitz Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by Ann H. Maitz in
Current site
Google Scholar
PubMed Close
 M.Sc.
,
Joseph A. Horton Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by Joseph A. Horton in
Current site
Google Scholar
PubMed Close
 M.D.
, and
Robert J. Coffey Departments of Neurological Surgery. Radiation Oncology, and Radiology, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania

Search for other papers by Robert J. Coffey in
Current site
Google Scholar
PubMed Close
 M.D.
Page Range:
512–524
Volume/Issue:
Volume 75: Issue 4
DOI link:
https://doi.org/10.3171/jns.1991.75.4.0512
Restricted access

Purchase Now

USD  $45.00

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

USD  $525.00

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

USD  $624.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

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

    USD  $525.00

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

    USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

✓ Stereotactic radiosurgery successfully obliterates carefully selected arteriovenous malformations (AVM's) of the brain. In an initial 3-year experience using the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 227 patients with AVM's were treated. Symptoms at presentation included prior hemorrhage in 143 patients (63%), headache in 104 (46%), and seizures in 70 (31%). Neurological deficits were present in 102 patients (45%). Prior surgical resection (resulting in subtotal removal) had been performed in 36 patients (16%). In 47 selected patients (21%), embolization procedures were performed in an attempt to reduce the AVM size prior to radiosurgery. The lesions were classified according to the Spetzler grading system: 64 (28%) were Grade VI (inoperable), 22 (10%) were Grade IV, 90 (40%) were Grade III, 43 (19%) were Grade II, and eight (4%) were Grade I. With the aid of computer imaging-integrated isodose plans for single-treatment irradiation, total coverage of the AVM nidus was possible in 216 patients (95%). The location and volume of the AVM were the most important factors for the selection of radiation dose. Magnetic resonance (MR) imaging was performed at 6-month intervals in 161 patients. Seventeen patients who had MR evidence of complete obliteration underwent angiography within 3 months of imaging: in 14 (82%) complete obliteration was confirmed. Complete angiographic obliteration was confirmed in 37 (80%) of 46 patients at 2 years, the earliest confirmation being 4 months (mean 17 months) after radiosurgery. The 2-year obliteration rates according to volume were: all eight (100%) AVM's less than 1 cu cm; 22 (85%) of 26 AVM's of 1 to 4 cu cm; and seven (58%) of 12 AVM's greater than 4 cu cm. Magnetic resonance imaging revealed postirradiation changes in 38 (24%) of 161 patients at a mean interval of 10.2 months after radiosurgery; only 10 (26%) of those 38 patients were symptomatic. In the entire series, two patients developed permanent new neurological deficits believed to be treatment-related. Two patients died of repeat hemorrhage at 6 and 23 months after treatment during the latency interval prior to obliteration.

Stereotactic radiosurgery is an important method to obliterate AVM's, especially those previously considered inoperable. Success and complication risks are related to the AVM location and the volume treated.

  • Collapse
  • Expand

Contributor Notes

Address for Dr. Coffey: Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.

Address reprint requests to: L. Dade Lunsford, M.D., Department of Neurological Surgery, Presbyterian-University Hospital, Room 9402, 230 Lothrop Street, Pittsburgh, Pennsylvania 15213.
  • 1.

    Altschuler EM, & Lunsford LD: Radiobiologic models for radiosurgery. Surg Forum 41:506–508, 1990 Altschuler EM, Lunsford LD: Radiobiologic models for radiosurgery. Surg Forum 41:506–508, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Altschuler EM, , Lunsford LD, & Coffey RJ, et al: Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 15:53–61, 1989 Altschuler EM, Lunsford LD, Coffey RJ, et al: Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 15:53–61, 1989

    • Search Google Scholar
    • Export Citation
  • 3.

    Andersen EB, , Petersen J, & Mortensen EL, et al: conservatively treated patients with cerebral arteriovenous malformation: mental and physical outcome. J Neurol Neurosurg Psychiatry 51:1208–1212, 1988 Andersen EB, Petersen J, Mortensen EL, et al: conservatively treated patients with cerebral arteriovenous malformation: mental and physical outcome. J Neurol Neurosurg Psychiatry 51:1208–1212, 1988

    • Search Google Scholar
    • Export Citation
  • 4.

    Betti OO, , Munari C, & Rosler R: Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 24:311–321, 1989 Betti OO, Munari C, Rosler R: Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 24:311–321, 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Burchiel KJ, , Clarke H, & Ojemann GA, et al: Use of stimulation mapping and corticography in the excision of arteriovenous malformations in sensorimotor and language — related neocortex. Neurosurgery 24:322–327, 1989 Burchiel KJ, Clarke H, Ojemann GA, et al: Use of stimulation mapping and corticography in the excision of arteriovenous malformations in sensorimotor and language — related neocortex. Neurosurgery 24:322–327, 1989

    • Search Google Scholar
    • Export Citation
  • 6.

    Colombo F, , Benedetti A, & Pozza F, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833–840, 1989 Colombo F, Benedetti A, Pozza F, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833–840, 1989

    • Search Google Scholar
    • Export Citation
  • 7.

    Crawford PM, , West CR, & Chadwick DW, et al: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:1–10, 1986 Crawford PM, West CR, Chadwick DW, et al: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49: 1–10, 1986

    • Search Google Scholar
    • Export Citation
  • 8.

    Dawson RC III, , Tarr RW, & Hecht ST, et al: Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery: results after 1 and 2 years. AJNR 11:857–864, 1990 Dawson RC III, Tarr RW, Hecht ST, et al: Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery: results after 1 and 2 years. AJNR 11:857–864, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Drake CG, , Friedman AH, & Peerless SJ: Posterior fossa arteriovenous malformations. J Neurosurg 64:1–10, 1986 Drake CG, Friedman AH, Peerless SJ: Posterior fossa arteriovenous malformations. J Neurosurg 64:1–10, 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Fabrikant JI, , Lyman JT, & Hosobuchi Y: Stereotactic heavy-ion Bragg peak radiosurgery for intra-cranial vascular disorders: method for treatment of deep arteriovenous malformations. Br J Radiol 57:479–490, 1984 Fabrikant JI, Lyman JT, Hosobuchi Y: Stereotactic heavy-ion Bragg peak radiosurgery for intra-cranial vascular disorders: method for treatment of deep arteriovenous malformations. Br J Radiol 57:479–490, 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Flickinger JC: An integrated logistic formula and prediction of complications from radiosurgery. Int J Radiat Oncol Biol Phys 17:879–885, 1989 Flickinger JC: An integrated logistic formula and prediction of complications from radiosurgery. Int J Radiat Oncol Biol Phys 17:879–885, 1989

    • Search Google Scholar
    • Export Citation
  • 12.

    Flickinger JC, , Lunsford LD, & Wu A, et al: Treatment planning for gamma knife radiosurgery with multiple isocenters. Int J Radiat Oncol Biol Phys 18:1495–1501, 1990 Flickinger JC, Lunsford LD, Wu A, et al: Treatment planning for gamma knife radiosurgery with multiple isocenters. Int J Radiat Oncol Biol Phys 18:1495–1501, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Fournier D, , TerBrugge K, & Rodesch G, et al: Revascularization of brain arteriovenous malformations after embolization with bucrylate. Neuroradiology 32:497–501, 1990 Fournier D, TerBrugge K, Rodesch G, et al: Revascularization of brain arteriovenous malformations after embolization with bucrylate. Neuroradiology 32:497–501, 1990

    • Search Google Scholar
    • Export Citation
  • 14.

    Fults D, & Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–662, 1984 Fults D, Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–662, 1984

    • Search Google Scholar
    • Export Citation
  • 15.

    Graf CJ, , Perret GE, & Torner JC: Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331–337, 1983 Graf CJ, Perret GE, Torner JC: Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331–337, 1983

    • Search Google Scholar
    • Export Citation
  • 16.

    Guidetti B, & Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149–152, 1980 Guidetti B, Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149–152, 1980

    • Search Google Scholar
    • Export Citation
  • 17.

    Heikkinen ER, , Konnov B, & Melnikov L, et al: Relief of epilepsy by radiosurgery of cerebral arteriovenous malformations. Stereotact Funct Neurosurg 53:157–166, 1989 Heikkinen ER, Konnov B, Melnikov L, et al: Relief of epilepsy by radiosurgery of cerebral arteriovenous malformations. Stereotact Funct Neurosurg 53:157–166, 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Heros RC, , Korosue K, & Deibold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–578, 1990 Heros RC, Korosue K, Deibold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–578, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Heros RC, & Tu YK: Is surgical therapy needed for unruptured arteriovenous malformations? Neurology 37:279–286, 1987 Heros RC, Tu YK: Is surgical therapy needed for unruptured arteriovenous malformations? Neurology 37:279–286, 1987

    • Search Google Scholar
    • Export Citation
  • 20.

    Itoyama Y, , Uemura S, & Ushio Y, et al: Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases. J Neurosurg 71:805–809, 1990 Itoyama Y, Uemura S, Ushio Y, et al: Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases. J Neurosurg 71:805–809, 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Jomin M, , Lesoin F, & Lozes G: Prognosis for arteriovenous malformations of the brain in adults based on 150 cases. Surg Neurol 23:362–366, 1985 Jomin M, Lesoin F, Lozes G: Prognosis for arteriovenous malformations of the brain in adults based on 150 cases. Surg Neurol 23:362–366, 1985

    • Search Google Scholar
    • Export Citation
  • 22.

    Karnofsky DA, & Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer, in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York: Columbia University Press, 1949, pp 191–205 Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer, in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York: Columbia University Press, 1949, pp 191–205

    • Search Google Scholar
    • Export Citation
  • 23.

    Kjellberg RN, , Hanamura T, & Davis KR, et al: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269–274, 1983 Kjellberg RN, Hanamura T, Davis KR, et al: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269–274, 1983

    • Search Google Scholar
    • Export Citation
  • 24.

    Kondziolka D, , Dempsey PK, & Lunsford LD: The case for conservative management of venous angiomas. Can J Neurol Sci ( In press, 1991) Kondziolka D, Dempsey PK, Lunsford LD: The case for conservative management of venous angiomas. Can J Neurol Sci (In press, 1991)

    • Search Google Scholar
    • Export Citation
  • 25.

    Kondziolka D, , Lunsford LD, & Coffey RJ, et al: Stereotactic radiosurgery of angiographically occult vascular malformations: indications and preliminary experience. Neurosurgery 27:892–900, 1990 Kondziolka D, Lunsford LD, Coffey RJ, et al: Stereotactic radiosurgery of angiographically occult vascular malformations: indications and preliminary experience. Neurosurgery 27:892–900, 1990

    • Search Google Scholar
    • Export Citation
  • 26.

    Levy RP, , Fabrikant JI, & Frankel KA, et al: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841–852, 1989 Levy RP, Fabrikant JI, Frankel KA, et al: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841–852, 1989

    • Search Google Scholar
    • Export Citation
  • 27.

    Lindquist C, & Steiner L: Stereotactic radiosurgical treatment of malformations of the brain, in Lunsford LD (ed): Modern Stereotactic Neurosurgery. Boston: Martinus Nijhoff, 1988, pp 491–505 Lindquist C, Steiner L: Stereotactic radiosurgical treatment of malformations of the brain, in Lunsford LD (ed): Modern Stereotactic Neurosurgery. Boston: Martinus Nijhoff, 1988, pp 491–505

    • Search Google Scholar
    • Export Citation
  • 28.

    Luessenhop AJ, & Rosa L: Cerebral arteriovenous malformations. Indications for and results of surgery, and the role of intravascular techniques. J Neurosurg 60:14–22, 1984 Luessenhop AJ, Rosa L: Cerebral arteriovenous malformations. Indications for and results of surgery, and the role of intravascular techniques. J Neurosurg 60:14–22, 1984

    • Search Google Scholar
    • Export Citation
  • 29.

    Lunsford LD, , Altschuler EM, & Flickinger JC, et al: In vivo biological effects of stereotactic radiosurgery: a primate model. Neurosurgery 27:373–382, 1990 Lunsford LD, Altschuler EM, Flickinger JC, et al: In vivo biological effects of stereotactic radiosurgery: a primate model. Neurosurgery 27:373–382, 1990

    • Search Google Scholar
    • Export Citation
  • 30.

    Lunsford LD, , Flickinger J, & Coffey RJ: Stereotactic gamma knife radiosurgery. Initial North American experience in 207 patients. Arch Neurol 47:169–175, 1990 Lunsford LD, Flickinger J, Coffey RJ: Stereotactic gamma knife radiosurgery. Initial North American experience in 207 patients. Arch Neurol 47:169–175, 1990

    • Search Google Scholar
    • Export Citation
  • 31.

    Lunsford LD, , Flickinger J, & Lindner G, et al: Stereotactic radiosurgery of the brain using the first United States 201 cobalt-60 source gamma knife. Neurosurgery 24:151–159, 1989 Lunsford LD, Flickinger J, Lindner G, et al: Stereotactic radiosurgery of the brain using the first United States 201 cobalt-60 source gamma knife. Neurosurgery 24:151–159, 1989

    • Search Google Scholar
    • Export Citation
  • 32.

    Malik GM, , Umansky F, & Patel S, et al: Microsurgical removal of arteriovenous malformations of the basal ganglia. Neurosurgery 23:209–217, 1988 Malik GM, Umansky F, Patel S, et al: Microsurgical removal of arteriovenous malformations of the basal ganglia. Neurosurgery 23:209–217, 1988

    • Search Google Scholar
    • Export Citation
  • 33.

    Ondra SL, , Troupp H, & George ED, et al: The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg 73:387–391, 1990 Ondra SL, Troupp H, George ED, et al: The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg 73:387–391, 1990

    • Search Google Scholar
    • Export Citation
  • 34.

    Perret G, & Nishioka H: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VI, Arteriovenous malformations. An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported by the Cooperative Study. J Neurosurg 25:467–490, 1966 Perret G, Nishioka H: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VI, Arteriovenous malformations. An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported by the Cooperative Study. J Neurosurg 25:467–490, 1966

    • Search Google Scholar
    • Export Citation
  • 35.

    Purdy PD, , Samson D, & Batjer HH, et al: Preoperative embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: experience in 51 adults. AJNR 11:501–510, 1990 Purdy PD, Samson D, Batjer HH, et al: Preoperative embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: experience in 51 adults. AJNR 11:501–510, 1990

    • Search Google Scholar
    • Export Citation
  • 36.

    Sadler LR, , Jungreis CA, & Trapanollo RT, et al: Angiographic technique in patients prior to gamma knife radiosurgery for intracranial arteriovenous malformations. AJNR 11:1157–1161, 1990 Sadler LR, Jungreis CA, Trapanollo RT, et al: Angiographic technique in patients prior to gamma knife radiosurgery for intracranial arteriovenous malformations. AJNR 11:1157–1161, 1990

    • Search Google Scholar
    • Export Citation
  • 37.

    Samson D, & Batjer H: Arteriovenous malformations of the cerebellar vermis. Neurosurgery 16:341–349, 1985 Samson D, Batjer H: Arteriovenous malformations of the cerebellar vermis. Neurosurgery 16:341–349, 1985

    • Search Google Scholar
    • Export Citation
  • 38.

    Solomon RA, & Stein BM: Management of arteriovenous malformations of the brain stem. J Neurosurg 64:857–864, 1986 Solomon RA, Stein BM: Management of arteriovenous malformations of the brain stem. J Neurosurg 64:857–864, 1986

    • Search Google Scholar
    • Export Citation
  • 39.

    Souhami L, , Olivier A, & Podgorsak EB, et al: Dynamic stereotactic radiosurgery in arteriovenous malformation. Preliminary treatment results. Cancer 66:15–20, 1990 Souhami L, Olivier A, Podgorsak EB, et al: Dynamic stereotactic radiosurgery in arteriovenous malformation. Preliminary treatment results. Cancer 66:15–20, 1990

    • Search Google Scholar
    • Export Citation
  • 40.

    Spetzler RF, & Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986 Spetzler RF, Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986

    • Search Google Scholar
    • Export Citation
  • 41.

    Spetzler RF, , Martin NA, & Carter LP, et al: Surgical management of large AVM's by staged embolization and operative excision. J Neurosurg 67:17–28, 1987 Spetzler RF, Martin NA, Carter LP, et al: Surgical management of large AVM's by staged embolization and operative excision. J Neurosurg 67:17–28, 1987

    • Search Google Scholar
    • Export Citation
  • 42.

    Statham P, , Macpherson P, & Johnston R, et al: Cerebral radiation necrosis complicating sterotactic radiosurgery for arteriovenous malformations. J Neurol Neurosurg Psychiatry 53:476–479, 1990 Statham P, Macpherson P, Johnston R, et al: Cerebral radiation necrosis complicating sterotactic radiosurgery for arteriovenous malformations. J Neurol Neurosurg Psychiatry 53:476–479, 1990

    • Search Google Scholar
    • Export Citation
  • 43.

    Steinberg GK, , Fabrikant JI, & Marks MP, et al: Stereotactic heavy-charged-particle Bragg-peak radiation for intracranial arteriovenous malformations. N Engl J Med 323:96–101, 1990 Steinberg GK, Fabrikant JI, Marks MP, et al: Stereotactic heavy-charged-particle Bragg-peak radiation for intracranial arteriovenous malformations. N Engl J Med 323:96–101, 1990

    • Search Google Scholar
    • Export Citation
  • 44.

    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 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
  • 45.

    Steiner L, & Lindquist CH: Radiosurgery in cerebral arteriovenous malformation, in Tasker RR (ed): Neurosurgery: State of the Art Reviews. Stereotactic Surgery. Philadelphia: Hanley & Belfus, 1987, pp 329–336 Steiner L, Lindquist CH: Radiosurgery in cerebral arteriovenous malformation, in Tasker RR (ed): Neurosurgery: State of the Art Reviews. Stereotactic Surgery. Philadelphia: Hanley & Belfus, 1987, pp 329–336

    • Search Google Scholar
    • Export Citation
  • 46.

    Sugita K, , Takemae T, & Kobayashi S: Sylvian fissure arteriovenous malformations. Neurosurgery 21:7–14, 1987 Sugita K, Takemae T, Kobayashi S: Sylvian fissure arteriovenous malformations. Neurosurgery 21:7–14, 1987

    • Search Google Scholar
    • Export Citation
  • 47.

    Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421–430, 1985 Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421–430, 1985

    • Search Google Scholar
    • Export Citation
  • 48.

    Wu A, , Lindner G, & Maitz AH, et al: Physics of gamma knife approach on convergent beams in stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 18:941–949, 1990 Wu A, Lindner G, Maitz AH, et al: Physics of gamma knife approach on convergent beams in stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 18:941–949, 1990

    • Search Google Scholar
    • Export Citation
  • 49.

    Yamada S, , Brauer FS, & Knierim DS: Direct approach to arteriovenous malformations in functional areas of the cerebral hemisphere. J Neurosurg 72:418–425, 1990 Yamada S, Brauer FS, Knierim DS: Direct approach to arteriovenous malformations in functional areas of the cerebral hemisphere. J Neurosurg 72:418–425, 1990

    • Search Google Scholar
    • Export Citation
  • 50.

    Yeh HS, , Kashiwagi S, & Tew JM Jr, et al: Surgical management of epilepsy associated with cerebral arteriovenous malformations. J Neurosurg 72:216–223, 1990 Yeh HS, Kashiwagi S, Tew JM Jr, et al: Surgical management of epilepsy associated with cerebral arteriovenous malformations. J Neurosurg 72:216–223, 1990

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2087 414 45
Full Text Views 528 50 10
PDF Downloads 307 52 7
EPUB Downloads 0 0 0