Stereotactic radiosurgery with neoadjuvant embolization of larger arteriovenous malformations: an institutional experience.

Journal Article

Objective

This study investigates the safety and efficacy of a multimodality approach combining staged endovascular embolizations with subsequent SRS for the management of larger AVMs.

Methods

Ninety-five patients with larger AVMs were treated with staged endovascular embolization followed by SRS between 1996 and 2011.

Results

The median volume of AVM in this series was 28 cm(3) and 47 patients (48%) were Spetzler-Martin grade IV or V. Twenty-seven patients initially presented with hemorrhage. Sixty-one patients underwent multiple embolizations while a single SRS session was performed in 64 patients. The median follow-up after SRS session was 32 months (range 9-136 months). Overall procedural complications occurred in 14 patients. There were 13 minor neurologic complications and 1 major complication (due to embolization) while four patients had posttreatment hemorrhage. Thirty-eight patients (40%) were cured radiographically. The postradiosurgery actuarial rate of obliteration was 45% at 5 years, 56% at 7 years, and 63% at 10 years. In multivariate analysis, larger AVM size, deep venous drainage, and the increasing number of embolization/SRS sessions were negative predictors of obliteration. The number of embolizations correlated positively with the number of stereotactic radiosurgeries (P < 0.005).

Conclusions

Multimodality endovascular and radiosurgical approach is an efficacious treatment strategy for large AVM.

Full Text

Duke Authors

Cited Authors

  • Dalyai, R; Theofanis, T; Starke, RM; Chalouhi, N; Ghobrial, G; Jabbour, P; Dumont, AS; Fernando Gonzalez, L; Gordon, DS; Rosenwasser, RH; Tjoumakaris, SI

Published Date

  • January 22, 2014

Published In

Volume / Issue

  • 2014 /

Start / End Page

  • 306518 -

PubMed ID

  • 24579080

Pubmed Central ID

  • 24579080

Electronic International Standard Serial Number (EISSN)

  • 2314-6141

International Standard Serial Number (ISSN)

  • 2314-6133

Digital Object Identifier (DOI)

  • 10.1155/2014/306518

Language

  • eng