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Clinical and neuroimaging outcome of cerebral arteriovenous malformations after Gamma Knife surgery: analysis of the radiation injury rate depending on the arteriovenous malformation volume

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Authors
Han, Jung Ho; Kim, Dong Gyu; Chung, Hyun-Tai; Park, Chul-Kee; Paek, Sun Ha; Kim, Jeong Eun; Jung, Hee-Won; Han, Dae Hee
Issue Date
2008-08
Publisher
American Association of Neurological Surgeons
Citation
J. Neurosurg. 109;191-198,2008
Keywords
adverse radiation effectcerebral arteriovenous malformationGamma Knife surgeryradiosurgery
Abstract
Object. In this paper the authors analyzed the clinical and neuroimaging outcomes of patients with cerebral
arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS), focusing on the analysis of the radiation
injury rate depending on the AVM volume.
Methods. Between 1997 and 2004, 277 consecutive patients with cerebral AVMs were treated with GKS. Of
these patients, 218 were followed up for ≥ 2 years. The mean age was 31 ± 15 years, the median AVM volume was
3.4 cm3 (range 0.17–35.2 cm3), the median marginal dose was 18.0 Gy (range 10.0–25.0 Gy), and the mean follow-up
duration was 44 ± 20 months. The authors reduced the prescription dose by various amounts, depending on the AVM
volume and location as prescribed in the classic guideline to avoid irreversible radiation injuries.
Results. The angiographic obliteration rate was 66.4% overall, and it was 81.7, 53.1, and 12.5% for small, medium,
and large AVMs, respectively. The overall annual bleeding rate was 1.9%. The annual bleeding rate was 0.44 and
4.64% for small and large AVMs, respectively. Approximately 20% of the patients showed severe postradiosurgery
imaging (PRI) changes. The rate of PRI change was 11.4, 33.3, and 9.5% for small, medium, and large AVM volume
groups, respectively, and a permanent radiation injury developed in 5.1% of patients.
Conclusions. By using the reduced dose from what is usually prescribed, the authors were able to obtain outcomes
in small AVMs that were comparable to the outcomes described in previous reports. However, medium AVMs
appear to still be at risk for adverse radiation effects. Last, in large AVMs, the authors were able to attain a tolerable
rate of radiation injury; however, the clinical outcomes were quite disappointing following administration of a reduced
dose of GKS for large AVMs.
ISSN
0022-3085
Language
English
URI
http://hdl.handle.net/10371/74206
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College of Medicine/School of Medicine (의과대학/대학원)Neurosurgery (신경외과학전공)Journal Papers (저널논문_신경외과학전공)
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