Results of deeply situated intracranial AVM's treated with gamma knife

Objective & Hypothesis:Deeply situated intracranial arteriovenous malformatioııs have more mortality and morbidity ratios, as they present anatomical difficulties in surgical approaches.

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Key Findings & Data:On the other hand, technically, deep location is not a complication increasing factor in radiosurgery. in this prospective study, first 50 patients with deep AVM's who have at least 2 year follow-up after gamma-knife treatment are evaluated.

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Conclusion & Impact:No mortality was detected in the deeply located AVM's and only one intracranial hemorrhage was detected in the latent period.

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:Arteriyovenöz malformasyonlar · Beyin · İleriye dönük çalışma

Abstract

Deeply situated intracranial arteriovenous malformatioııs have more mortality and morbidity ratios, as they present anatomical difficulties in surgical approaches. On the other hand, technically, deep location is not a complication increasing factor in radiosurgery. in this prospective study, first 50 patients with deep AVM's who have at least 2 year follow-up after gamma-knife treatment are evaluated. Ali 50 deep situated AVM's revealed a decrease in their nidus volumes. in 44 (88%) cases AVM oclusion was complete, 4 AVM's (8%) showed 50-80% decrease in their nidus volumes, and 2 other (4%) displayed only venous drainage. Six (12%) AVM cases demonstrated radiological T2 image changes around the AVM nidus, in the normal brain tissue, in 3 (6%) cases these changes caused neurologically permanent deficits. No mortality was detected in the deeply located AVM's and only one intracranial hemorrhage was detected in the latent period.

Özet

Derin yerleşim gösteren arteriovenöz malformasyonlar (AVM) cerrahi ulaşım zorluğu ve bulundukları anatomik yapıların önemli fizyolojik fonksiyonları nedeniyle diğer AVM'lere göre daha yüksek cerrahi mortalite ve morbidite oranlarına sahiptirler. Mikrocerrahi yaklaşımları için komplikasyon oranlarını arttıran anatomik ulaşım zorluğu faktörü,stereotaktik ışın-cerrahisi için teknik bir zorluk faktörü değildir. Bu özellikleri nedeniyle derin AVM'ler ayrı bir alt grup olarak değerlendirilmişlerdir. Prospektif bu çalışmada, Gamma-Knife uygulanan derin yerleşimli AVM olgularından en az 2 yıllık anjiografik kontrolü bulunan ilk 50 olgunun klinik ve nöroradyolojik özellikleri gözden geçirilmiştir. Derin AVM tanılı 50 olgunun tamamında nidus boyutlarında değişme görülmüştür. AVM nidus boyutunda değişiklik görülen 50 olgunun 44'ünde (%88) tam kapanma, 4'ünde (%8) %50-80 küçülme ve 2'sinde (%4) ise sadece venöz dönüş saptanmıştır. Derin AVM olgularının 6'sında (%12) nidus çevresindeki beyin dokusunda radyasyona bağlı T2 değişiklikleri görülmüş, 3 hastada (%6) bu değişiklikler kalıcı nörolojik kusurların oluşmasına yol açmıştır. Derin AVM'lerde mortalite ile karşılaşılmamıştır. iki yıllık izlemi bulunan ilk 50 hastadan yalnızca l'inde (%2) latent dönem AVM kanaması görülmüştür. Bu sonuçlarla Gamma-Knife tedavisi derin AVM'lerde, geometrik açıdan uygun olan hastalarda, mikrocerrahiyle birlikte değerlendirilmesi gereken bir tedavi yöntemidir.

Keywords

Arteriyovenöz malformasyonlar Beyin İleriye dönük çalışma Radyocerrahi Arteriovenous Malformations Brain Prospective Studies Radiosurgery

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Cite This Article

KONYA, D., KILIÇ, T., PEKER, S., ÇEKİRGE, S., BALTACIOĞLU, F., PAMİR, M. N. (2004). Results of deeply situated intracranial AVM's treated with gamma knife. Türk Serebrovasküler Hastalıklar Dergisi, Cilt: 10 - Sayı: 1, 51–56. https://ajindex.com/articles/357809

References (2)

Apostolides PJ, Lawton MT, Smith KA, Spetzler RF. Embolization and radiosurgery for AVMs. J Neurosurg 1997.86 (2): 318-9; discussion 320-1
Friedman WA. Radiosurgery for arteriovenous malformations. Clin Neurosurg 1995.42: 328-47, 3. Stein BM, Mohr JP, Sisti MB. Is radiosurgery all that it appears to be? Arch Neurol 1991.48: 19-20, 4. Steiner L, Lindquist C, Cail W, Karlsson B, Steiner M. Microsurgery and radiosurgery in brain arteriovenous malformations. J Neurosurg 1993.79: 647-52, 5. Stieg PE, Friedlander RM, Loeffler JS, Alexander E, 3rd. Arteriovenous malformations: indications for stereotactic radiosusgery. Clin Neurosurg 2000.47: 242-8, 6. Chang SD, Adler JR, Jr. Current status and optimal use of radiosurgery. Oncology (Huntingt) 2001.15 (2): 209-16; discussion 219-21, 7. Hall EJ,.sBrenner DJ. The radiobiology of radiosurgery: rationale for different treatment regimes for AVMs and malignancies. Int J Radiat Oncol Biol Phys 1993:5: 381-5., 8. Kondziolka D, Lunsford LD, Flickinger JC.The radiobiology of radiosurgery. Neurosurg Clin N Am 1999.10: 157-66, 9. Larson DA, Flickinger JC, Loeffler JS. The radiobiology of radiosurgery. Int J Radiat Oncol Biol Phys 1993.25: 557-61, 10. Steiner L, Lindquist C, Adler JR, Torner JC, Alves W, Steiner M: Clinical outcome of radiosurgery for cerebral arteriovenous malformations. J Neurosurg 1992.77:1-8, 11 Steiner L, Lindquist C, Steiner M. Radiosurgery. Adv Tech Stand Neurosurg 1992.19: 19-102, 12 Bednarz G, Downes B, Werner-Wasik M, Rosenwasser RH. Combining stereotactic angiography and 3D time-of-flight magnetic resonance angiography in treatment planning for arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 2000.46: 1149-54, 13. Deruty R, Pelissou-Guyotat I, Amat D, Mottolese C, Bascoulergue Y, Turjman F, Gerard JP. Complications after multidisciplinary treatment of cerebral arteriovenous malformations. Acta Neurochir 1996.138: 119-31, 14. Ezura M, Takahashi A, Jokura H, Shirane R, Yoshimoto T. Endovascular treatment of aneurysms associated with cerebral arteriovenous malformations: experiences after the introduction of Guglielmi detachable coils. J Clin Neurosci 2000.7: 14-18, 15. Kobayashi S, Hongo K, Bhagwati SN, Rappaport ZH, Lawton MT, Spetzler RF. Management of arteriovenous malformations: Part II. Surg Neurol 1997.48: 2-6, 16. Karlsson B, Lax I, Soderman M. Can the probability for obliteration after radiosurgery for arteriovenous malformations be accurately predicted? Int J Radia