Gamma Knife surgery for arteriovenous malformations within or adjacent to the ventricles

Clinical article

Greg Bowden M.D., M.Sc.1,3,4, Hideyuki Kano M.D., Ph.D.1,3, Huai-che Yang M.D.1,3,5, Ajay Niranjan M.Ch., M.B.A.1,3, John Flickinger M.D.2,3, and L. Dade Lunsford M.D.1,3
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  • 1 Departments of Neurological Surgery and
  • | 2 Radiation Oncology, and
  • | 3 Center for Image-Guided Neurosurgery, University of Pittsburgh, Pennsylvania;
  • | 4 University of Western Ontario, London, Ontario, Canada; and
  • | 5 Taipei Veterans General Hospital, Taipei City, Taiwan
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Object

The outcomes of stereotactic radiosurgery for arteriovenous malformations (AVMs) within or adjacent to the ventricular system are largely unknown. This study assessed the long-term outcomes and hemorrhage risks for patients with AVMs within this region who underwent Gamma Knife surgery (GKS) at the University of Pittsburgh.

Methods

The authors retrospectively identified 188 patients with ventricular-region AVMs who underwent a single-stage GKS procedure during a 22-year interval. The median patient age was 32 years (range 3–80 years), the median target volume was 4.6 cm3 (range 0.1–22 cm3), and the median marginal dose was 20 Gy (range 13–27 Gy).

Results

Arteriovenous malformation obliteration was confirmed by MRI or angiography in 89 patients during a median follow-up of 65 months (range 2–265 months). The actuarial rates of total obliteration were 32% at 3 years, 55% at 4 years, 60% at 5 years, and 64% at 10 years. Higher rates of AVM obliteration were obtained in the 26 patients with intraventricular AVMs. Twenty-five patients (13%) sustained a hemorrhage during the initial latency interval after GKS, indicating an annual hemorrhage rate of 3.4% prior to AVM obliteration. No patient experienced a hemorrhage after AVM obliteration was confirmed by imaging. Permanent neurological deficits due to adverse radiation effects developed in 7 patients (4%).

Conclusions

Although patients in this study demonstrated an elevated hemorrhage risk that remained until complete obliteration, GKS still proved to be a generally safe and effective treatment for patients with these high-risk intraventricular and periventriclar AVMs.

Abbreviations used in this paper:

AVM = arteriovenous malformation; GKS = Gamma Knife surgery.

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