Gamma Knife surgery for large cerebral arteriovenous malformations.

Hae Yu Kim, Won Seok Chang, Dong Joon Kim, Jae Whan Lee, JinWoo Chang, Dong Ik Kim, Seung Kon Huh, Yong Gou Park, Jong Hee Chang

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Treatment of arteriovenous malformations (AVMs) is problematic due to many factors, including lesion size, lesion location, unacceptable complications, and negative outcomes. To overcome the limitation imposed by a large nidus volume, neurosurgeons have used Gamma Knife surgery (GKS) in a variety of ways, including combined with other treatment modalities, as volume-staged radiosurgery, and as repeat radiosurgery. We performed repeat radiosurgeries in patients who harbored large AVMs (> 30 cm(3)) and analyzed the AVM obliteration rates and complications. The authors reviewed the cases of 44 patients at a single institution who underwent GKS between 1992 and 2007 for treatment of an AVM whose nidus was 30 cm(3) or larger. The mean age of the patients was 27 years (range 4.5-62.3 years), and the median duration of follow-up was 109.4 months (range 27-202 months). The mean AVM nidus volume was 48.8 cm(3) (range 30.3-109.5 cm(3)), and the mean radiation dose delivered to the margin of the nidus was 13.9 Gy (range 8.4-17.5 Gy). The authors determined complete AVM nidus obliteration based on findings on both MR images and digital subtraction angiograms. When they did not detect complete obliteration after GKS, they performed 1 or more additional GKSs separated by a minimum interval of 3 years. The overall obliteration rate following repeat GKS was 34.1%, and the estimated obliteration rate at 120 months was 41.8%. Three patients (6.8%) experienced hemorrhages after GKS, and 2 patients (4.5%) developed cysts. One patient (2.3%) experienced a newly developed seizure following GKS, and another patient (2.3%) was found to have radiation necrosis. Even though complete obliteration of the large AVMs after repeat GKS took a long time, the complication rate was quite acceptable. In addition, the estimated obliteration rate at long-term follow-up was respectable. Repeat GKS should be considered as a primary treatment option for symptomatic large AVMs to overcome the limitation imposed on successful obliteration by the large volume of the nidus.

Original languageEnglish
Pages (from-to)2-8
Number of pages7
JournalJournal of Neurosurgery
Volume113 Suppl
Publication statusPublished - 2010 Jan 1

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Intracranial Arteriovenous Malformations
Arteriovenous Malformations
Radiosurgery
Radiation
Therapeutics
Cysts
Angiography
Seizures
Necrosis
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Kim, H. Y., Chang, W. S., Kim, D. J., Lee, J. W., Chang, J., Kim, D. I., ... Chang, J. H. (2010). Gamma Knife surgery for large cerebral arteriovenous malformations. Journal of Neurosurgery, 113 Suppl, 2-8.
Kim, Hae Yu ; Chang, Won Seok ; Kim, Dong Joon ; Lee, Jae Whan ; Chang, JinWoo ; Kim, Dong Ik ; Huh, Seung Kon ; Park, Yong Gou ; Chang, Jong Hee. / Gamma Knife surgery for large cerebral arteriovenous malformations. In: Journal of Neurosurgery. 2010 ; Vol. 113 Suppl. pp. 2-8.
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Kim, HY, Chang, WS, Kim, DJ, Lee, JW, Chang, J, Kim, DI, Huh, SK, Park, YG & Chang, JH 2010, 'Gamma Knife surgery for large cerebral arteriovenous malformations.', Journal of Neurosurgery, vol. 113 Suppl, pp. 2-8.

Gamma Knife surgery for large cerebral arteriovenous malformations. / Kim, Hae Yu; Chang, Won Seok; Kim, Dong Joon; Lee, Jae Whan; Chang, JinWoo; Kim, Dong Ik; Huh, Seung Kon; Park, Yong Gou; Chang, Jong Hee.

In: Journal of Neurosurgery, Vol. 113 Suppl, 01.01.2010, p. 2-8.

Research output: Contribution to journalArticle

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AU - Kim, Dong Ik

AU - Huh, Seung Kon

AU - Park, Yong Gou

AU - Chang, Jong Hee

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AB - Treatment of arteriovenous malformations (AVMs) is problematic due to many factors, including lesion size, lesion location, unacceptable complications, and negative outcomes. To overcome the limitation imposed by a large nidus volume, neurosurgeons have used Gamma Knife surgery (GKS) in a variety of ways, including combined with other treatment modalities, as volume-staged radiosurgery, and as repeat radiosurgery. We performed repeat radiosurgeries in patients who harbored large AVMs (> 30 cm(3)) and analyzed the AVM obliteration rates and complications. The authors reviewed the cases of 44 patients at a single institution who underwent GKS between 1992 and 2007 for treatment of an AVM whose nidus was 30 cm(3) or larger. The mean age of the patients was 27 years (range 4.5-62.3 years), and the median duration of follow-up was 109.4 months (range 27-202 months). The mean AVM nidus volume was 48.8 cm(3) (range 30.3-109.5 cm(3)), and the mean radiation dose delivered to the margin of the nidus was 13.9 Gy (range 8.4-17.5 Gy). The authors determined complete AVM nidus obliteration based on findings on both MR images and digital subtraction angiograms. When they did not detect complete obliteration after GKS, they performed 1 or more additional GKSs separated by a minimum interval of 3 years. The overall obliteration rate following repeat GKS was 34.1%, and the estimated obliteration rate at 120 months was 41.8%. Three patients (6.8%) experienced hemorrhages after GKS, and 2 patients (4.5%) developed cysts. One patient (2.3%) experienced a newly developed seizure following GKS, and another patient (2.3%) was found to have radiation necrosis. Even though complete obliteration of the large AVMs after repeat GKS took a long time, the complication rate was quite acceptable. In addition, the estimated obliteration rate at long-term follow-up was respectable. Repeat GKS should be considered as a primary treatment option for symptomatic large AVMs to overcome the limitation imposed on successful obliteration by the large volume of the nidus.

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Kim HY, Chang WS, Kim DJ, Lee JW, Chang J, Kim DI et al. Gamma Knife surgery for large cerebral arteriovenous malformations. Journal of Neurosurgery. 2010 Jan 1;113 Suppl:2-8.