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

研究成果: Article

28 引用 (Scopus)

抄録

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.

元の言語English
ページ(範囲)43-52
ページ数10
ジャーナルSurgical Neurology
71
発行部数1
DOI
出版物ステータスPublished - 2009 1
外部発表Yes

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Intracranial Arteriovenous Malformations
Radiosurgery
Cysts
Morbidity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

これを引用

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.

:: Surgical Neurology, 巻 71, 番号 1, 01.2009, p. 43-52.

研究成果: Article

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. :: Surgical Neurology. 2009 ; 巻 71, 番号 1. pp. 43-52.
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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.",
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AB - 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.

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