Abstract:
BACKGROUND:Treatment of giant cerebral arteriovenous malformations (AVMs) remains a challenge. OBJECTIVE:To propose hypofractionated stereotactic radiotherapy (HSRT) as a part of staged treatment, and evaluate its effect by analyzing AVM volume changes. METHODS:From 2001 to 2007, 20 AVMs larger than 5 cm were treated by HSRT and followed up using magnetic resonance imaging. Patients' median age was 34 years (8-61 years). Eleven patients presented with hemorrhage and 9 with seizure. Ten patients had previous embolization and radiosurgery had failed in 4. Thirteen AVMs (65%) were classified as Spetzler-Martin grade V and 7 as grade IV. Median pretreatment volume was 46.84 cm³ (12.51-155.38 cm³). Dose was 25 to 30 Gy in 5 to 6 daily fractions. Median follow-up was 32 months. RESULTS:Median AVM volume decreased to 13.51 cm³ (range, 0.55-147.14 cm³). Residual volume varied from 1.5% to 98%. Volume decreased 44% every year on average. We noted that 6-Gy fractions were more effective (P = .040); embolized AVM tended to respond less (P = .085). After HSRT, we reirradiated 4 AVMs, with 3 amenable to single dose and one with fractions. After HSRT, one patient had an ischemic stroke and one had increased seizure frequency. One AVM bled during follow-up (2.06%/year). No complete obliteration was confirmed. CONCLUSION:HSRT can turn some giant AVMs manageable for single-dose radiosurgery. Six-Gray fractions were better than 5-Gy and routine embolization seemed unhelpful. There was no increase in bleeding risk with this approach. Future studies with longer follow-up are necessary to confirm our observation.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Xiao F,Gorgulho AA,Lin CS,Chen CH,Agazaryan N,Viñuela F,Selch MT,De Salles AAdoi
10.1227/NEU.0b013e3181efbaefsubject
Has Abstractpub_date
2010-11-01 00:00:00pages
1253-9; discussion 1259issue
5eissn
0148-396Xissn
1524-4040pii
00006123-201011000-00012journal_volume
67pub_type
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