Long-term Results of Gamma Knife Surgery for Partially Embolized Arteriovenous Malformations.


1Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA 2Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.



The effectiveness and risk of Gamma Knife surgery (GKS) in the management of partially embolized cerebral arteriovenous malformations (AVMs) remain to be elucidated.


To evaluate the long-term imaging and clinical outcomes of GKS in AVM patients who had undergone prior partial embolization and compare the results with patients treated with GKS alone.


A total of 215 embolized AVMs were analyzed. The mean age was 32.9 years. The mean volume of the nidus was 4.6 cc (range 0.1-29.4 cc) and the mean prescription dose was 19.6 Gy (range 4-28 Gy). This group was compared with 729 non-embolized AVMs.


Following embolization and GKS, angiographically confirmed total obliteration of the AVMs was significantly lower (33%) when compared with patients where GKS was used alone (60.9%; p< 0.001). However, the mean nidus size was larger and the Spetzler Martin grade was higher for the embolized AVMs compared to the non-embolized AVMs. Radiation-induced changes occurred more often in the embolized (43.4%) than the non-embolized (33.4%) AVMs (p=0.028). Permanent neurological deficits associated with radiation-induced changes occurred in 2.7% of the embolized versus 1.3% of the non-embolized patients (p=0.14).


In our retrospective and historical series, the long-term results suggest that the obliteration rate is significantly lower in embolized AVMs versus non-embolized AVMs also due to the fact that the combined treatment is applied to higher grade AVMs; the percentage of grade III - V AVMs was 58.6% and 48.8% for non-embolized AVMs.
[PubMed - as supplied by publisher]

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