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

Abstract

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.more » 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.« less

Authors:
; ; ; ;  [1]
  1. (Univ. of Pittsburgh, PA (USA))
Publication Date:
OSTI Identifier:
5892675
Resource Type:
Journal Article
Journal Name:
Neurosurgery; (USA)
Additional Journal Information:
Journal Volume: 27:6; Journal ID: ISSN 0148-396X
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; VASCULAR DISEASES; RADIOTHERAPY; BRAIN; COBALT 60; HEMORRHAGE; MAN; NMR IMAGING; PATIENTS; RECOMMENDATIONS; ANIMALS; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BODY; CENTRAL NERVOUS SYSTEM; COBALT ISOTOPES; DIAGNOSTIC TECHNIQUES; DISEASES; INTERMEDIATE MASS NUCLEI; INTERNAL CONVERSION RADIOISOTOPES; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; MAMMALS; MEDICINE; MINUTES LIVING RADIOISOTOPES; NERVOUS SYSTEM; NUCLEAR MEDICINE; NUCLEI; ODD-ODD NUCLEI; ORGANS; PATHOLOGICAL CHANGES; PRIMATES; RADIOISOTOPES; RADIOLOGY; SYMPTOMS; THERAPY; VERTEBRATES; YEARS LIVING RADIOISOT; 550603* - Medicine- External Radiation in Therapy- (1980-); 550600 - Medicine

Citation Formats

Kondziolka, D., Lunsford, L.D., Coffey, R.J., Bissonette, D.J., and Flickinger, J.C. Stereotactic radiosurgery of angiographically occult vascular malformations: Indications and preliminary experience. United States: N. p., 1990. Web. doi:10.1097/00006123-199012000-00006.
Kondziolka, D., Lunsford, L.D., Coffey, R.J., Bissonette, D.J., & Flickinger, J.C. Stereotactic radiosurgery of angiographically occult vascular malformations: Indications and preliminary experience. United States. doi:10.1097/00006123-199012000-00006.
Kondziolka, D., Lunsford, L.D., Coffey, R.J., Bissonette, D.J., and Flickinger, J.C. Sat . "Stereotactic radiosurgery of angiographically occult vascular malformations: Indications and preliminary experience". United States. doi:10.1097/00006123-199012000-00006.
@article{osti_5892675,
title = {Stereotactic radiosurgery of angiographically occult vascular malformations: Indications and preliminary experience},
author = {Kondziolka, D. and Lunsford, L.D. and Coffey, R.J. and Bissonette, D.J. and Flickinger, J.C.},
abstractNote = {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.},
doi = {10.1097/00006123-199012000-00006},
journal = {Neurosurgery; (USA)},
issn = {0148-396X},
number = ,
volume = 27:6,
place = {United States},
year = {1990},
month = {12}
}