Combined management of intracranial arteriovenous malformations with embolization and Gamma Knife radiosurgery

comparative evaluation of the long-term results

Masahiro Izawa, Mikhail Chernov, Motohiro Hayashi, Hiroshi Iseki, Tomokatsu Hori, Kintomo Takakura

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Volume reduction of large AVMs attained with endovascular embolization can be potentially helpful for their subsequent radiosurgical management. The objective of the present retrospective analysis was comparative evaluation of the long-term outcome after GKR for intracranial AVM performed with and without initial embolization of the nidus. Methods: The long-term outcome in 15 patients with intracranial AVM treated with initial embolization and subsequent GKR was evaluated and compared with the series of 237 patients treated during the same period solely with GKR. All patients were followed at least 2 years after radiosurgery. Results: Mean reductions of the nidus volume and score of the radiosurgery-based grading system for AVMs after embolization constituted 6.9 ± 2.4 mL and 0.7 ± 0.2, respectively (P < .001). Complete obliteration of the nidus after GKR was marked in 10 cases (67%). It was attained in 9 (90%) of 10 AVMs with postembolization nidus volume less than 12 mL, and in 1 (20%) of 5 with postembolization nidus volume more than 12 mL (P < .05). Delayed cyst formation was met once (7%). Obliteration and long-term morbidity rates did not differ significantly in patients treated with and without preradiosurgical nidus embolization, whereas nidus volume was seemingly larger in the former cohort. Conclusions: Combined management with embolization and GKR may be effective for selected cases of large intracranial AVM. Radiosurgery preceded by partial nidus embolization does not associate with increased rate of long-term complications.

Original languageEnglish
Pages (from-to)43-52
Number of pages10
JournalSurgical Neurology
Volume71
Issue number1
DOIs
Publication statusPublished - 2009 Jan
Externally publishedYes

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Intracranial Arteriovenous Malformations
Radiosurgery
Cysts
Morbidity

Keywords

  • AVM
  • Combined management
  • Embolization
  • Gamma Knife radiosurgery
  • Outcome

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Combined management of intracranial arteriovenous malformations with embolization and Gamma Knife radiosurgery : comparative evaluation of the long-term results. / Izawa, Masahiro; Chernov, Mikhail; Hayashi, Motohiro; Iseki, Hiroshi; Hori, Tomokatsu; Takakura, Kintomo.

In: Surgical Neurology, Vol. 71, No. 1, 01.2009, p. 43-52.

Research output: Contribution to journalArticle

Izawa, Masahiro ; Chernov, Mikhail ; Hayashi, Motohiro ; Iseki, Hiroshi ; Hori, Tomokatsu ; Takakura, Kintomo. / Combined management of intracranial arteriovenous malformations with embolization and Gamma Knife radiosurgery : comparative evaluation of the long-term results. In: Surgical Neurology. 2009 ; Vol. 71, No. 1. pp. 43-52.
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