Stereotactic radiosurgery for arteriovenous malformations of the brain

Journal Article · Tue Oct 01 00:00:00 EDT 1991 · Journal of Neurosurgery; (United States)

DOI:https://doi.org/10.3171/jns.1991.75.4.0512· OSTI ID:5012462

Lunsford, L D; Kondziolka, D; Flickinger, J C; Bissonette, D J; Jungreis, C A; Maitz, A H; Horton, J A; Coffey, R J ^[1]

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1. Department of Neurological Surgery, University Hospital, University of Pittsburgh, PA (United States)

Stereotactic radiosurgery successfully obliterates carefully selected arteriovenous malformations (AVM's) of the brain. In an initial 3-year experience using the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 227 patients with AVM's were treated. Symptoms at presentation included prior hemorrhage in 143 patients (63%), headache in 104 (46%), and seizures in 70 (31%). Neurological deficits were present in 102 patients (45%). Prior surgical resection (resulting in subtotal removal) had been performed in 36 patients (16%). In 47 selected patients (21%), embolization procedures were performed in an attempt to reduce the AVM size prior to radiosurgery. The lesions were classified according to the Spetzler grading system: 64 (28%) were Grade VI (inoperable), 22 (10%) were Grade IV, 90 (40%) were Grade III, 43 (19%) were Grade II, and eight (4%) were Grade I. With the aid of computer imaging-integrated isodose plans for single-treatment irradiation, total coverage of the AVM nidus was possible in 216 patients (95%). The location and volume of the AVM were the most important factors for the selection of radiation dose. Magnetic resonance (MR) imaging was performed at 6-month intervals in 161 patients. Seventeen patients who had MR evidence of complete obliteration underwent angiography within 3 months of imaging: in 14 (82%) complete obliteration was confirmation being 4 months (mean 17 months) after radiosurgery. The 2-year obliteration rates according to volume were: all eight (100%) AVM's less than 1 cu cm; 22 (85%) of 26 AVM's of 1 to 4 cu cm; and seven (58%) of 12 AVM's greater than 4 cu cm. Magnetic resonance imaging revealed postirradiation changes in 38 (24%) of 161 patients at a mean interval of 10.2 months after radiosurgery; only 10 (26%) of those 38 patients were symptomatic.

• OSTI ID: 5012462
• Journal Information: Journal of Neurosurgery; (United States), Vol. 75:4; ISSN 0022-3085
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
VASCULAR DISEASES
RADIOTHERAPY
BRAIN
COBALT 60
GAMMA RADIATION
NMR IMAGING
PATIENTS
RADIATION DOSES
SURVIVAL CURVES
SYMPTOMS
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BODY
CENTRAL NERVOUS SYSTEM
COBALT ISOTOPES
DIAGNOSTIC TECHNIQUES
DISEASES
DOSES
ELECTROMAGNETIC RADIATION
INTERMEDIATE MASS NUCLEI
INTERNAL CONVERSION RADIOISOTOPES
IONIZING RADIATIONS
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MEDICINE
MINUTES LIVING RADIOISOTOPES
NERVOUS SYSTEM
NUCLEAR MEDICINE
NUCLEI
ODD-ODD NUCLEI
ORGANS
RADIATIONS
RADIOISOTOPES
RADIOLOGY
THERAPY
YEARS LIVING RADIOISOT
550603* - Medicine- External Radiation in Therapy- (1980-)