Treatment of giant cerebral arteriovenous malformation: hypofractionated stereotactic radiation as the first stage.

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

Neurosurgery

journal_title

Neurosurgery

authors

Xiao F,Gorgulho AA,Lin CS,Chen CH,Agazaryan N,Viñuela F,Selch MT,De Salles AA

doi

10.1227/NEU.0b013e3181efbaef

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

1253-9; discussion 1259

issue

5

eissn

0148-396X

issn

1524-4040

pii

00006123-201011000-00012

journal_volume

67

pub_type

杂志文章
  • Neuroprotection with intraventricular brain-derived neurotrophic factor in rat venous occlusion model.

    abstract:BACKGROUND:The increasing number of neurosurgical procedures for elderly patients and the development of skull base neurosurgery have increased interest in cerebral venous injury that might occur in a neurosurgical setting. Brain-derived neurotrophic factor (BDNF) may have neuroprotective effects against cerebral venou...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/NEU.0b013e31820c048e

    authors: Takeshima Y,Nakamura M,Miyake H,Tamaki R,Inui T,Horiuchi K,Wajima D,Nakase H

    更新日期:2011-05-01 00:00:00

  • Carotid arteriotomy closure using a vascular clip system.

    abstract:PURPOSE:To compare a newly released vascular clip system (Vascular Clip-applier System; Auto Suture Company, Norwalk, CT) designed for sutureless vessel closures and anastomoses with standard suture closure of carotid arteriotomies after carotid endarterectomies. PATIENTS AND METHODS:Sixteen consecutive patients with ...

    journal_title:Neurosurgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00006123-199803000-00024

    authors: Findlay JM,Megyesi JF

    更新日期:1998-03-01 00:00:00

  • Dural reconstruction with fascia, titanium mesh, and bone screws: technical note.

    abstract:OBJECTIVE:After the resection of cranial base tumors, there may not be enough free dural margin left for reconstruction after involved bone and dura have been removed. In such a situation, dural reconstruction becomes a problem. We propose a new technique of dural closure in such cases. METHODS:A fascial graft is prep...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-200109000-00043

    authors: Sekhar LN,Sarma S,Morita A

    更新日期:2001-09-01 00:00:00

  • Anosmia after anterior communicating artery aneurysm surgery: comparison between the anterior interhemispheric and basal interhemispheric approaches.

    abstract::The olfactory function could be examined in 101 of 138 patients with anterior communicating artery aneurysms, whom we treated during a recent 6-year period. Among them, 49 patients underwent surgery by the anterior interhemispheric approach and 52 underwent surgery by the basal interhemispheric approach. Fifteen patie...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-199602000-00017

    authors: Fujiwara H,Yasui N,Nathal-Vera E,Suzuki A

    更新日期:1996-02-01 00:00:00

  • History of the Department of Neurosurgery at Thomas Jefferson University Hospital.

    abstract::The neurosurgical tradition at Jefferson Medical College began in the 19th century with Samuel Gross. In his textbook entitled A System of Surgery, Gross revealed his knowledge of the disorders of the nervous system at a time when innovations were practically inexistent. Gross' work paved the way for William Williams ...

    journal_title:Neurosurgery

    pub_type: 历史文章,杂志文章

    doi:10.1227/01.neu.0000430299.02714.46

    authors: Chalouhi N,Osterholm J,Jabbour P,Dumont AS,Gonzalez LF,Harrop J,Sharan A,Rosenwasser R,Tjoumakaris S

    更新日期:2013-10-01 00:00:00

  • The paraclinoid carotid artery: anatomical aspects of a microneurosurgical approach.

    abstract::The paraclinoid area is investigated anatomically for possible microneurosurgical approaches to the C3 segment of the internal carotid artery and to structures in the vicinity of the anterior siphon knee. Removal of the anterior clinoid process reveals a tight connective tissue ring that fixes the internal carotid art...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:

    authors: Knosp E,Müller G,Perneczky A

    更新日期:1988-05-01 00:00:00

  • Cerebral Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Comparison of Management Approaches.

    abstract:BACKGROUND:Autosomal dominant polycystic kidney disease (ADPKD) is a risk factor for formation of intracranial aneurysms (IAs), though the ideal screening and treatment strategies in this population are unclear. OBJECTIVE:To report outcomes of observation, open surgical, or endovascular management of ruptured and unru...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1093/neuros/nyy336

    authors: Wilkinson DA,Heung M,Deol A,Chaudhary N,Gemmete JJ,Thompson BG,Pandey AS

    更新日期:2019-06-01 00:00:00

  • Volumetric follow-up of meningiomas: a quantitative method to evaluate treatment outcome of gamma knife radiosurgery.

    abstract:OBJECTIVE:The most important treatment options for meningiomas are microsurgery, radiotherapy, and gamma knife radiosurgery (GKRS). The efficacy of GKRS in terms of local tumor control and tumor volume (TV) reduction can best be determined by accurate analysis of changes in tumor size in pre- and post-GKRS images. In t...

    journal_title:Neurosurgery

    pub_type: 临床试验,杂志文章

    doi:10.1227/01.NEU.0000279999.95953.EA

    authors: Feigl GC,Samii M,Horstmann GA

    更新日期:2007-08-01 00:00:00

  • Prophylactic hypervolemia without calcium channel blockers in early aneurysm surgery.

    abstract::Delayed ischemic neurological deficit (DIND) remains a major unsolved problem in the management of aneurysmal subarachnoid hemorrhage (SAH). For many years, the complications reported with acute aneurysm surgery caused surgeons to operate late after SAH. In a 42-month-period, we managed 146 patients with aneurysm and/...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199201000-00003

    authors: Medlock MD,Dulebohn SC,Elwood PW

    更新日期:1992-01-01 00:00:00

  • The role of intraoperative ultrasound imaging in the surgical removal of intramedullary cavernous angiomas.

    abstract::Five intramedullary cavernous angiomas were surgically removed after being localized by intraoperative ultrasound imaging. Two patients were men, and three were women; in three patients, the symptoms had an acute onset, whereas in the other two, it was gradual. The vascular malformation was localized in the dorsal tra...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199403000-00020

    authors: Lunardi P,Acqui M,Ferrante L,Fortuna A

    更新日期:1994-03-01 00:00:00

  • Microsurgical resection of solitary intramedullary spinal cord metastases.

    abstract::Two cases of solitary intramedullary spinal cord metastasis treated primarily by surgical excision are presented. It has been generally thought that appropriate management for the rare metastasis within the spinal cord is radiation and corticosteroids. The excellent palliative results obtained in our patients suggest ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198712000-00022

    authors: Findlay JM,Bernstein M,Vanderlinden RG,Resch L

    更新日期:1987-12-01 00:00:00

  • Virtual reality cerebral aneurysm clipping simulation with real-time haptic feedback.

    abstract:BACKGROUND:With the decrease in the number of cerebral aneurysms treated surgically and the increase of complexity of those treated surgically, there is a need for simulation-based tools to teach future neurosurgeons the operative techniques of aneurysm clipping. OBJECTIVE:To develop and evaluate the usefulness of a n...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/NEU.0000000000000583

    authors: Alaraj A,Luciano CJ,Bailey DP,Elsenousi A,Roitberg BZ,Bernardo A,Banerjee PP,Charbel FT

    更新日期:2015-03-01 00:00:00

  • Fatal phenytoin-related toxic epidermal necrolysis: case report.

    abstract::Toxic epidermal necrolysis is a rare but often fatal hypersensitivity reaction to numerous agents, including most anticonvulsants. The authors present a case of fatal phenytoin-related toxic epidermal necrolysis in a patient who was given prophylactic anticonvulsant therapy after he sustained a moderately severe close...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-198912000-00022

    authors: Kelly DF,Hope DG

    更新日期:1989-12-01 00:00:00

  • Clinical problem-solving: brachial plexus closed injury and reconstruction.

    abstract:OBJECTIVE:Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded. METHODS:The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive h...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.neu.0000333305.57060.00

    authors: Ranalli NJ,Kline DG,McGarvey ML,Boulis NM,Zager EL

    更新日期:2008-06-01 00:00:00

  • Neurosurgery and Manned Spaceflight.

    abstract::There has been a renewed interest in manned spaceflight due to endeavors by private and government agencies. Publicized goals include manned trips to or colonization of Mars. These missions will likely be of long duration, exceeding existing records for human exposure to extra-terrestrial conditions. Participants will...

    journal_title:Neurosurgery

    pub_type: 杂志文章,评审

    doi:10.1093/neuros/nyy531

    authors: Panesar SS,Fernandez-Miranda JC,Kliot M,Ashkan K

    更新日期:2020-03-01 00:00:00

  • Thiamine-deficient encephalopathy in association with aneurysmal subarachnoid hemorrhage: a case report.

    abstract::An alcoholic man who was admitted with an acute onset of neck pain and confusion was diagnosed as suffering from a subarachnoid hemorrhage after rupture of an anterior communicating artery aneurysm. Additionally, he showed a bilateral 6th nerve palsy of variable extent. The postoperative course was complicated by pulm...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199304000-00028

    authors: Valdueza JM,Puchner MJ,Herrmann HD

    更新日期:1993-04-01 00:00:00

  • Air sinus wounds: an analysis of 163 consecutive cases incurred in the Korean War, 1950-1952.

    abstract::Review of 1105 records patients with penetrating craniocerebral injuries incurred in the Korean War revealed 163 cases with air sinus wounds, an incidence of 14.8%. The characteristics of these wounds and their surgical management have been described. Foremost among the complications of air sinus wounds are the develo...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198310000-00005

    authors: Arendall RE,Meirowsky AM

    更新日期:1983-10-01 00:00:00

  • Organization of head injury service in Beijing.

    abstract::Beijing, the capital of the People's Republic of China, is a city with a population of over 10 million. The incidence of head injuries is increasing yearly and the government pays much attention to this social and medical problem. This is evidenced in both county and big city hospitals by the organization of neurosurg...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198208000-00023

    authors: Cheng M

    更新日期:1982-08-01 00:00:00

  • Retained language in dysgenic cortex: case report.

    abstract::Since the advent of magnetic resonance imaging, there has been renewed interest in disorders of cortical migration in the cause of focal epilepsy. The function of dysplastic cortex is poorly understood. We report a 46-year-old woman in whom this was assessed by intraoperative stimulation. This left-handed patient had ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199511000-00020

    authors: Leblanc R,Robitaille Y,Andermann F,Ptito A

    更新日期:1995-11-01 00:00:00

  • Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa.

    abstract:OBJECTIVE:The supraorbital approach is well accepted for lesions in the anterior fossa, the sellar region, and the anterior circle of Willis. However, the usefulness of this approach has not yet been elucidated for lesions in the interpeduncular fossa. The technique of an endoscope-assisted, ipsi- and contralateral sup...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-199901000-00062

    authors: Menovsky T,Grotenhuis JA,de Vries J,Bartels RH

    更新日期:1999-01-01 00:00:00

  • Hydrocephalus-induced changes in the composition of cerebrospinal fluid.

    abstract::Studies reporting the composition of cerebrospinal fluid obtained from hydrocephalic humans have been critically reviewed. Hydrocephalus-induced alterations in the cerebrospinal fluid concentrations of neurotransmitters and peptide neuromodulators, products of glycolysis and nucleotide metabolism, neural cell-derived ...

    journal_title:Neurosurgery

    pub_type: 杂志文章,评审

    doi:10.1097/00006123-198909000-00016

    authors: Del Bigio MR

    更新日期:1989-09-01 00:00:00

  • Cephaloceles: treatment, outcome, and antenatal diagnosis.

    abstract::A series of 74 cephaloceles (17 cranial meningoceles and 57 meningoencephaloceles) is reported. Infants born with large meningoencephaloceles containing recognizable cerebral tissue usually did badly despite endeavors to conserve brain function by expanding the cranial capacity (5 cases) or decompressing hydrocephalic...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198407000-00005

    authors: Simpson DA,David DJ,White J

    更新日期:1984-07-01 00:00:00

  • Image-guided endoscopic transnasal removal of recurrent pituitary adenomas.

    abstract:OBJECTIVE:To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. METHODS:During a 45-month period, 19 endoscopic endonasal transsphenoidal reoperations were performed for recurrent pituitary adenomas. In 11 of 19 patients, the procedure was ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-200207000-00020

    authors: Lasio G,Ferroli P,Felisati G,Broggi G

    更新日期:2002-07-01 00:00:00

  • Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review.

    abstract:BACKGROUND:Infection is a significant cause of morbidity with cranioplasty procedures. However, few studies have investigated the effect of specific surgical practices on cranioplasty infection. OBJECTIVE:To analyze the literature on the effect of early surgery (within 3 months of craniectomy), implant material, and m...

    journal_title:Neurosurgery

    pub_type: 杂志文章,评审

    doi:10.1227/NEU.0b013e31820a5470

    authors: Yadla S,Campbell PG,Chitale R,Maltenfort MG,Jabbour P,Sharan AD

    更新日期:2011-04-01 00:00:00

  • Suspension laminotomy: a new surgical technique for compression myelopathy.

    abstract::In an attempt to eliminate the many negative aspects of conventional extensive laminectomy, we originated in 1981 and have developed a new surgical technique called "suspension laminotomy." A basic principle of this operation is preservation and repair of the soft and bony tissue of the spine with osseous enlargement ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198712000-00033

    authors: Ohmori K,Ishida Y,Suzuki K

    更新日期:1987-12-01 00:00:00

  • Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas.

    abstract:OBJECTIVE:It remains unknown whether the extent of surgical resection affects survival or disease progression in patients with supratentorial low-grade gliomas. METHODS:We conducted a retrospective cohort study (n = 170) between 1996 and 2007 at a single institution to determine whether increasing extent of surgical r...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.NEU.0000325729.41085.73

    authors: McGirt MJ,Chaichana KL,Attenello FJ,Weingart JD,Than K,Burger PC,Olivi A,Brem H,Quinoñes-Hinojosa A

    更新日期:2008-10-01 00:00:00

  • Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery.

    abstract:OBJECTIVE:Repair of a cerebrospinal fluid (CSF) leak created at the time of transsphenoidal surgery typically involves placement of a fat, fascial, or muscle graft and sellar floor reconstruction. In this report, a simplified repair for small, "weeping" CSF leaks using collagen sponge is described. METHODS:All patient...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-200110000-00020

    authors: Kelly DF,Oskouian RJ,Fineman I

    更新日期:2001-10-01 00:00:00

  • Colored silicone injection for use in neurosurgical dissections: anatomic technical note.

    abstract:OBJECTIVE:The dissection of cadaveric specimens is very important for a more sophisticated understanding of neurosurgical anatomic features and approaches. Teaching known approaches to residents or learning new approaches is best performed in a cadaveric laboratory. The utility of neurosurgical cadaveric dissections ca...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-199911000-00058

    authors: Sanan A,Abdel Aziz KM,Janjua RM,van Loveren HR,Keller JT

    更新日期:1999-11-01 00:00:00

  • Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Myelomeningocele: Whether Prenatal or Postnatal Closure Affects Future Ambulatory Status.

    abstract:BACKGROUND:Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure. OBJECTIVE:The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-...

    journal_title:Neurosurgery

    pub_type: 杂志文章,实务指引

    doi:10.1093/neuros/nyz263

    authors: Bauer DF,Beier AD,Nikas DC,Assassi N,Blount J,Durham SR,Flannery AM,Klimo P Jr,McClung-Smith C,Rehring P,Tamber MS,Tyagi R,Mazzola CA

    更新日期:2019-09-01 00:00:00

  • Multiphoton excitation of autofluorescence for microscopy of glioma tissue.

    abstract:OBJECTIVE:Intraoperative detection of residual tumor tissue in glioma surgery remains an important challenge because the extent of tumor removal is related to the prognosis of the disease. Multiphoton excited fluorescence tomography of living tissues provides high-resolution structural and photochemical imaging at a su...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.NEU.0000204885.45644.22

    authors: Leppert J,Krajewski J,Kantelhardt SR,Schlaffer S,Petkus N,Reusche E,Hüttmann G,Giese A

    更新日期:2006-04-01 00:00:00