gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Radiosurgery of arteriovenous malformations in the interdisciplinary concept of treatment and after-treatment care

Meeting Abstract

  • K. Hamm - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • R. Gerlach - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • G. Kleinert - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • G. Surber - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • J. Klisch - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.03

DOI: 10.3205/11dgnc068, URN: urn:nbn:de:0183-11dgnc0684

Published: April 28, 2011

© 2011 Hamm et al.
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Outline

Text

Objective: Radiosurgery (RS) represents an additional therapy available for arteriovenous malformations (AVM). Results and progressive observations were analyzed.

Methods: Data from 60 patients (age: 11 – 76, median: 62 years, treated between 2000 and 2008) were reviewed retrospectively. Spetzler-Martin grade at diagnosis was assessed: grade I in 2 patients, II in 8, III in 32 and IV in 18. Before RS, 22 patients had experienced bleeding, 17 presented with seizures, 12 with hemiparesis and 5 with aphasia or vertigo, respectively. The mean volume of the AVM was 3.5 ccm (0.2- 17 ccm).The median radiation dose delivered to the margin was 16 Gy (12-20 Gy). The mean follow-up period was 38.5 months (14-96 months). 5 patients underwent microsurgical resection and 18 patients underwent partial embolization of the AVM before RS was employed. Until now, reliable follow-up data on 42 patients is available, 4 patients with larger AVM (> 20 ccm nidus volume) received a hypofractionated stereotactic radiotherapy and were eliminated from this analysis. 14 patients were lost to follow-up 6-12 months after RS.

Results: Angiographic follow-up was performed in 17 patients demonstrating complete AVM obliteration in all these cases. Concerning 3D-MRI and 3D-TOF-MRA, 36 of the 42 patients (85.7%) showed complete obliteration of the AVM and the other 6 (143%) demonstrated a partial response. No patient presented with post-RS hemorrhage. Adverse radiation effects (ARE) were observed on follow-up MRI in 27 patients (64.3%): 15 mild, 10 moderate and 2 severe reactions. A temporary increase in the existing disorders occurred in 22 patients, 9 of whom had additional symptoms. Complete obliteration was confirmed in 22 of 24 patients (91.7%) with volumes < 4 ccm and 14 of 18 patients (77.8%) with volumes > 4 ccm, respectively. The complete obliteration rate was 96.4% with a marginal dose of 16 Gy or above, 75% with 15 Gy and 64.3% with < 15 Gy. The nidus structure was without influence of ARE and clinical follow-up.

Conclusions: RS can provide high rates of obliteration with an acceptable risk of morbidity. Following RS, detectable irradiation reactions in neuroimaging can lead to false interpretations. Therefore, as in the therapeutic planning, follow-up care must involve the interdisciplinary cooperations.