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Acta Neurochirurgica
Published in: Acta Neurochirurgica 12/2009

01-12-2009 | Clinical Article

Gamma knife radiosurgery for arteriovenous malformations of basal ganglia, thalamus and brainstem—a retrospective study comparing the results with that for AVMs at other intracranial locations

Authors: Narayanam Anantha Sai Kiran, Shashank Sharad Kale, Manish Kumar Kasliwal, Sandeep Vaishya, Aditya Gupta, Manish Singh Sharma, Bhawani Shankar Sharma, Ashok Kumar Mahapatra

Published in: Acta Neurochirurgica | Issue 12/2009

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Abstract

Objective

The objective of this retrospective study was to study the outcome in patients with basal ganglia, thalamus and brainstem (central/deep) arteriovenous malformations (AVMs) treated with gamma knife radiosurgery (GKS) and to compare the results with that for AVMs at other intracranial locations.

Methods and results

The results of 53 patients with central AVMs and 255 patients with AVMs at other locations treated with GKS at our center between April 1997 and March 2005 with minimum follow-up of 1 year were analyzed.

Central AVMs

Forty of these 53 AVMs were Spetzler-Martin grade III, 11 were grade IV, and 2 were grade V. The mean AVM volume was 4.3 cm3 (range 0.1–36.6 cm3). The mean marginal dose given was 23.3 Gy (range 16–25 Gy). The mean follow-up was 28 months (range 12–96 months). Check angiograms were advised at 2 years after GKS and yearly thereafter in the presence of residual AVM till 4 years. Presence of a residual AVM on an angiogram at 4 years after radiosurgery was considered as radiosurgical failure. Complete obliteration of the AVM was documented in 14 (74%) of the 19 patients with complete angiographic follow-up. Significantly lower obliteration rates (37% vs. 100%) were seen in larger AVMs (>3 cm3) and AVMs of higher (IV and V) Spetzler-Martin grades (28% vs. 100%). The 3- and 4-year actuarial rates of nidus obliteration were 68% and 74%, respectively. Eight patients (15%) developed radiation edema with a statistically significantly higher incidence in patients with AVM volume >3 cm3 and in patients with Spetzler-Martin grade IV and V AVMs. Five patients (9.4%) had hemorrhage in the period of latency.

Comparison of results with AVMs at other locations

Patients with central AVMs presented at a younger age (mean age 22.7 years vs. 29 years), with a very high proportion (81% vs. 63%) presenting with hemorrhage. Significantly higher incidence of radiation edema (15% vs. 5%) and lower obliteration rates (74% vs. 93%) were seen in patients with central AVMs.

Conclusions

GKS is an effective modality of treatment for central AVMs, though relatively lower obliteration rates and higher complication rates are seen compared to AVMs at other locations.
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Metadata
Title
Gamma knife radiosurgery for arteriovenous malformations of basal ganglia, thalamus and brainstem—a retrospective study comparing the results with that for AVMs at other intracranial locations
Authors
Narayanam Anantha Sai Kiran
Shashank Sharad Kale
Manish Kumar Kasliwal
Sandeep Vaishya
Aditya Gupta
Manish Singh Sharma
Bhawani Shankar Sharma
Ashok Kumar Mahapatra
Publication date
01-12-2009
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 12/2009
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-009-0335-0

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