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

Published

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

  • 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

Digital Object Identifier (DOI)

  • 10.1155/2014/306518

Language

  • eng

Conference Location

  • United States