Stereotactic radiosurgery of angiographically occult vascular malformations: Indications and preliminary experience

Journal Article · Sat Dec 01 04:00:00 EST 1990 · Neurosurgery; (USA)

DOI:https://doi.org/10.1097/00006123-199012000-00006· OSTI ID:5892675

Kondziolka, D; Lunsford, L D; Coffey, R J; Bissonette, D J; Flickinger, J C ^[1]

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1. Univ. of Pittsburgh, PA (USA)

Stereotactic radiosurgery has been shown to treat successfully angiographically demonstrated arteriovenous malformations of the brain. Angiographic obliteration has represented cure and eliminated the risk of future hemorrhage. The role of radiosurgery in the treatment of angiographically occult vascular malformations (AOVMs) has been less well defined. In the initial 32 months of operation of the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 24 patients meeting strict criteria for high-risk AOVMs were treated. Radiosurgery was used conservatively; each patient had sustained two or more hemorrhages and had a magnetic resonance imaging-defined AOVM located in a region of the brain where microsurgical removal was judged to pose an excessive risk. Venous angiomas were excluded by performance of high-resolution subtraction angiography in each patient. Fifteen malformations were in the medulla, pons, and/or mesencephalon, and 5 were located in the thalamus or basal ganglia. Follow-up ranged from 4 to 24 months. Nineteen patients either improved or remained clinically stable and did not hemorrhage again during the follow-up interval. One patient suffered another hemorrhage 7 months after radiosurgery. Five patients experienced temporary worsening of pre-existing neurological deficits that suggested delayed radiation injury. Magnetic resonance imaging demonstrated signal changes and edema surrounding the radiosurgical target. Dose-volume guidelines for avoiding complications were constructed. Our initial experience indicates that stereotactic radiosurgery can be performed safely in patients with small, well-circumscribed AOVMs located in deep, critical, or relatively inaccessible cerebral locations.

• OSTI ID: 5892675
• Journal Information: Neurosurgery; (USA), Journal Name: Neurosurgery; (USA) Vol. 27:6; ISSN 0148-396X; ISSN NRSRD
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
ANIMALS
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BODY
BRAIN
CENTRAL NERVOUS SYSTEM
COBALT 60
COBALT ISOTOPES
DIAGNOSTIC TECHNIQUES
DISEASES
HEMORRHAGE
INTERMEDIATE MASS NUCLEI
INTERNAL CONVERSION RADIOISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MAMMALS
MAN
MEDICINE
MINUTES LIVING RADIOISOTOPES
NERVOUS SYSTEM
NMR IMAGING
NUCLEAR MEDICINE
NUCLEI
ODD-ODD NUCLEI
ORGANS
PATHOLOGICAL CHANGES
PATIENTS
PRIMATES
RADIOISOTOPES
RADIOLOGY
RADIOTHERAPY
RECOMMENDATIONS
SYMPTOMS
THERAPY
VASCULAR DISEASES
VERTEBRATES
YEARS LIVING RADIOISOT