http://cjns.metapress.com/content/b4033p6374152516/?id=B4033P6374152516
Abstract
Background: Stereotactic radiosurgery (SRS) is known
to safely result in a high obliteration rate for small and medium sized
arteriovenous malformations (AVM). Objective: To evaluate
the long-term outcome of patients treated with SRS, with special
emphasis given to obliteration and toxicity rates. Methods:
We performed a review of 43 cerebral AVM patients, treated from 1998 to
2008 with a single SRS dose ranging from 21-25 Gy. Of these, 37 had a
minimal follow-up of one year. Medical files were reviewed to assess
patient and AVM characteristics, the SRS treatment, therapy prior to
SRS, the obliteration rate and toxicities. Whenever necessary, outcome
data was supplemented by telephone interviews with the patient or
treating physician. Results: AVM size was ≥3cm in diameter
in 21% of patients. Five patients (11.6%) underwent surgery prior to
SRS and 31 patients (72.1%) received one or more embolizations prior to
SRS. Of the patients followed with angiography ≥1 year post-SRS, 89%
(33/37) had a complete obliteration of the nidus, after a median time of
24.7 months post-treatment. Embolization prior to SRS was not
predictive of outcome. One patient suffered a non-fatal haemorrhage
between treatment and obliteration. The rate of symptomatic
radiation-induced radiological changes was 8.1%. Conclusion:
Our study shows both obliteration and complication rates in the upper
limit of those reported in the literature. SRS seems an attractive
treatment option for small AVMs. Unlike other reports, the prior use of
embolization did not impact negatively on obliteration rates.
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