Stereotactic radiosurgery with neoadjuvant embolization of larger arteriovenous malformations: an institutional experience.

Abstract:

OBJECTIVE:This study investigates the safety and efficacy of a multimodality approach combining staged endovascular embolizations with subsequent SRS for the management of larger AVMs. METHODS:Ninety-five patients with larger AVMs were treated with staged endovascular embolization followed by SRS between 1996 and 2011. RESULTS:The median volume of AVM in this series was 28 cm(3) and 47 patients (48%) were Spetzler-Martin grade IV or V. Twenty-seven patients initially presented with hemorrhage. Sixty-one patients underwent multiple embolizations while a single SRS session was performed in 64 patients. The median follow-up after SRS session was 32 months (range 9-136 months). Overall procedural complications occurred in 14 patients. There were 13 minor neurologic complications and 1 major complication (due to embolization) while four patients had posttreatment hemorrhage. Thirty-eight patients (40%) were cured radiographically. The postradiosurgery actuarial rate of obliteration was 45% at 5 years, 56% at 7 years, and 63% at 10 years. In multivariate analysis, larger AVM size, deep venous drainage, and the increasing number of embolization/SRS sessions were negative predictors of obliteration. The number of embolizations correlated positively with the number of stereotactic radiosurgeries (P < 0.005). CONCLUSIONS:Multimodality endovascular and radiosurgical approach is an efficacious treatment strategy for large AVM.

journal_name

Biomed Res Int

authors

Dalyai R,Theofanis T,Starke RM,Chalouhi N,Ghobrial G,Jabbour P,Dumont AS,Fernando Gonzalez L,Gordon DS,Rosenwasser RH,Tjoumakaris SI

doi

10.1155/2014/306518

subject

Has Abstract

pub_date

2014-01-01 00:00:00

pages

306518

eissn

2314-6133

issn

2314-6141

journal_volume

2014

pub_type

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