Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery
Subtotal obliteration of cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS) implies a complete angiographic disappearance of the AVM nidus but persistence of an early filling draining vein, indicating that residual shunting is still present; hence, per definition there is st...
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| Veröffentlicht in: | Journal of neurosurgery 2007-03, Vol.106 (3), p.361-369 |
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| creator | CHUN PO YEN VARADY, Peter SHEEHAN, Jason STEINER, Melita STEINER, Ladislau |
| description | Subtotal obliteration of cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS) implies a complete angiographic disappearance of the AVM nidus but persistence of an early filling draining vein, indicating that residual shunting is still present; hence, per definition there is still a patent AVM and the risk of bleeding is not eliminated. The aim of this study was to determine the risk of hemorrhage for patients with subtotal obliteration of AVMs.
After GKS for cerebral AVMs, follow-up angiography demonstrated a subtotally obliterated lesion in 159 patients. Of these, in 16 patients a subtotally obliterated AVM developed after a second GKS was performed for the partially obliterated lesion. The mean age of these patients was 35.2 years at the time of the diagnosis of subtotally obliterated AVMs. The lesion volumes at the time of initial GKS treatment ranged from 0.1 to 11.5 cm3 (mean 2.5 cm3). The mean peripheral dose used in the 175 GKS treatments was 22.5 Gy (median 23 Gy, range 15-31 Gy). To achieve total obliteration of the AVM, 23 patients underwent a new GKS targeting the proximal end of the early filling vein. The mean peripheral dose given in these cases was 23 Gy (median 24, range 18-25 Gy). The incidence of subtotally obliterated AVMs was 7.6% from a total of 2093 AVMs treated and in which follow-up imaging was available. The diagnosis of subtotally obliterated AVMs was made a mean of 29.4 months (range 4-178 months) after GKS. The number of patient-years at risk (from the time of the diagnosis of subtotally obliterated AVMs until either the confirmation of a total obliteration of the lesion on angiography or the time of the latest follow-up angiographic study that still visualized the early filling vein) was a mean of 3.9 years, ranging from 0.5 to 13.5 years, and a total of 601 patient-years. There was no case of bleeding after the diagnosis of subtotally obliterated AVMs. Of 90 patients who did not undergo further treatment and in whom follow-up angiography studies were available, the same early filling veins still filled in 24 (26.7%), and the subtotally obliterated AVMs were subsequently obliterated in 66 patients (73.3%). In 19 patients who underwent repeated GKS for subtotally obliterated AVMs and in whom follow-up angiography studies were available, the AVMs were obliterated in 15 (78.9%) and remained patent in four (21.1%).
The fact that none of the patients with subtotally obliterated AVMs suffered a rupture is not c |
| doi_str_mv | 10.3171/jns.2007.106.3.361 |
| format | Article |
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After GKS for cerebral AVMs, follow-up angiography demonstrated a subtotally obliterated lesion in 159 patients. Of these, in 16 patients a subtotally obliterated AVM developed after a second GKS was performed for the partially obliterated lesion. The mean age of these patients was 35.2 years at the time of the diagnosis of subtotally obliterated AVMs. The lesion volumes at the time of initial GKS treatment ranged from 0.1 to 11.5 cm3 (mean 2.5 cm3). The mean peripheral dose used in the 175 GKS treatments was 22.5 Gy (median 23 Gy, range 15-31 Gy). To achieve total obliteration of the AVM, 23 patients underwent a new GKS targeting the proximal end of the early filling vein. The mean peripheral dose given in these cases was 23 Gy (median 24, range 18-25 Gy). The incidence of subtotally obliterated AVMs was 7.6% from a total of 2093 AVMs treated and in which follow-up imaging was available. The diagnosis of subtotally obliterated AVMs was made a mean of 29.4 months (range 4-178 months) after GKS. The number of patient-years at risk (from the time of the diagnosis of subtotally obliterated AVMs until either the confirmation of a total obliteration of the lesion on angiography or the time of the latest follow-up angiographic study that still visualized the early filling vein) was a mean of 3.9 years, ranging from 0.5 to 13.5 years, and a total of 601 patient-years. There was no case of bleeding after the diagnosis of subtotally obliterated AVMs. Of 90 patients who did not undergo further treatment and in whom follow-up angiography studies were available, the same early filling veins still filled in 24 (26.7%), and the subtotally obliterated AVMs were subsequently obliterated in 66 patients (73.3%). In 19 patients who underwent repeated GKS for subtotally obliterated AVMs and in whom follow-up angiography studies were available, the AVMs were obliterated in 15 (78.9%) and remained patent in four (21.1%).
The fact that none of the patients with subtotally obliterated AVMs suffered a rupture is not compatible with the assumption of an unchanged risk of hemorrhage for these lesions, and implies that the protection from rebleeding in patients with subtotal obliteration is significant. Subtotal obliteration does not necessarily seem to be a stage of an ongoing obliteration. At least in some cases it represents an end point of this process, with no subsequent obliteration occurring. This observation requires further confirmation by open-ended follow-up imaging.</description><identifier>ISSN: 0022-3085</identifier><identifier>EISSN: 1933-0693</identifier><identifier>DOI: 10.3171/jns.2007.106.3.361</identifier><identifier>PMID: 17367056</identifier><identifier>CODEN: JONSAC</identifier><language>eng</language><publisher>Park Ridge, IL: American Association of Neurological Surgeons</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Cerebral Hemorrhage - etiology ; Child ; Female ; Follow-Up Studies ; Humans ; Intracranial Arteriovenous Malformations - complications ; Intracranial Arteriovenous Malformations - diagnostic imaging ; Intracranial Arteriovenous Malformations - surgery ; Male ; Medical sciences ; Middle Aged ; Neurosurgery ; Radiography ; Radiosurgery ; Retreatment ; Retrospective Studies ; Risk Assessment ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of neurosurgery, 2007-03, Vol.106 (3), p.361-369</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c331t-7d10c0dad16bccd07bf02c872f26a5194776c1cdbeff187bb5cd308808f453d73</citedby><cites>FETCH-LOGICAL-c331t-7d10c0dad16bccd07bf02c872f26a5194776c1cdbeff187bb5cd308808f453d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18561607$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17367056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CHUN PO YEN</creatorcontrib><creatorcontrib>VARADY, Peter</creatorcontrib><creatorcontrib>SHEEHAN, Jason</creatorcontrib><creatorcontrib>STEINER, Melita</creatorcontrib><creatorcontrib>STEINER, Ladislau</creatorcontrib><title>Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery</title><title>Journal of neurosurgery</title><addtitle>J Neurosurg</addtitle><description>Subtotal obliteration of cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS) implies a complete angiographic disappearance of the AVM nidus but persistence of an early filling draining vein, indicating that residual shunting is still present; hence, per definition there is still a patent AVM and the risk of bleeding is not eliminated. The aim of this study was to determine the risk of hemorrhage for patients with subtotal obliteration of AVMs.
After GKS for cerebral AVMs, follow-up angiography demonstrated a subtotally obliterated lesion in 159 patients. Of these, in 16 patients a subtotally obliterated AVM developed after a second GKS was performed for the partially obliterated lesion. The mean age of these patients was 35.2 years at the time of the diagnosis of subtotally obliterated AVMs. The lesion volumes at the time of initial GKS treatment ranged from 0.1 to 11.5 cm3 (mean 2.5 cm3). The mean peripheral dose used in the 175 GKS treatments was 22.5 Gy (median 23 Gy, range 15-31 Gy). To achieve total obliteration of the AVM, 23 patients underwent a new GKS targeting the proximal end of the early filling vein. The mean peripheral dose given in these cases was 23 Gy (median 24, range 18-25 Gy). The incidence of subtotally obliterated AVMs was 7.6% from a total of 2093 AVMs treated and in which follow-up imaging was available. The diagnosis of subtotally obliterated AVMs was made a mean of 29.4 months (range 4-178 months) after GKS. The number of patient-years at risk (from the time of the diagnosis of subtotally obliterated AVMs until either the confirmation of a total obliteration of the lesion on angiography or the time of the latest follow-up angiographic study that still visualized the early filling vein) was a mean of 3.9 years, ranging from 0.5 to 13.5 years, and a total of 601 patient-years. There was no case of bleeding after the diagnosis of subtotally obliterated AVMs. Of 90 patients who did not undergo further treatment and in whom follow-up angiography studies were available, the same early filling veins still filled in 24 (26.7%), and the subtotally obliterated AVMs were subsequently obliterated in 66 patients (73.3%). In 19 patients who underwent repeated GKS for subtotally obliterated AVMs and in whom follow-up angiography studies were available, the AVMs were obliterated in 15 (78.9%) and remained patent in four (21.1%).
The fact that none of the patients with subtotally obliterated AVMs suffered a rupture is not compatible with the assumption of an unchanged risk of hemorrhage for these lesions, and implies that the protection from rebleeding in patients with subtotal obliteration is significant. Subtotal obliteration does not necessarily seem to be a stage of an ongoing obliteration. At least in some cases it represents an end point of this process, with no subsequent obliteration occurring. This observation requires further confirmation by open-ended follow-up imaging.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cerebral Hemorrhage - etiology</subject><subject>Child</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intracranial Arteriovenous Malformations - complications</subject><subject>Intracranial Arteriovenous Malformations - diagnostic imaging</subject><subject>Intracranial Arteriovenous Malformations - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Radiography</subject><subject>Radiosurgery</subject><subject>Retreatment</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-3085</issn><issn>1933-0693</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1LAzEQhoMotlb_gAfZi952nSTdZHuUolUseFDxGPIpW3Y3NdkV-u9N7UJPA-88M8w8CF1jKCjm-H7TxYIA8AIDK2hBGT5BU7ygNAe2oKdoCkBITqEqJ-gixg0AZnNGztEEc8o4lGyKvt4H1fteNplXTd3bIPvad5l3mbbBqpAaMqS49r-280PMWtk4H9p_LGbSpV62km0rs9eudjaLQ_i2YXeJzpxsor0a6wx9Pj1-LJ_z9dvqZfmwzjWluM-5waDBSIOZ0toAVw6IrjhxhMkSL-acM421UdY5XHGlSm3SQxVUbl5Sw-kM3R32boP_GWzsRVtHbZtGdjadKzgQzivOEkgOoA4-xmCd2Ia6lWEnMIi9TpF0ir3OFDBBRdKZhm7G7YNqrTmOjP4ScDsCMupkJshO1_HIVSXDDDj9A_cpgBI</recordid><startdate>20070301</startdate><enddate>20070301</enddate><creator>CHUN PO YEN</creator><creator>VARADY, Peter</creator><creator>SHEEHAN, Jason</creator><creator>STEINER, Melita</creator><creator>STEINER, Ladislau</creator><general>American Association of Neurological Surgeons</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070301</creationdate><title>Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery</title><author>CHUN PO YEN ; VARADY, Peter ; SHEEHAN, Jason ; STEINER, Melita ; STEINER, Ladislau</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c331t-7d10c0dad16bccd07bf02c872f26a5194776c1cdbeff187bb5cd308808f453d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cerebral Hemorrhage - etiology</topic><topic>Child</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intracranial Arteriovenous Malformations - complications</topic><topic>Intracranial Arteriovenous Malformations - diagnostic imaging</topic><topic>Intracranial Arteriovenous Malformations - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Radiography</topic><topic>Radiosurgery</topic><topic>Retreatment</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CHUN PO YEN</creatorcontrib><creatorcontrib>VARADY, Peter</creatorcontrib><creatorcontrib>SHEEHAN, Jason</creatorcontrib><creatorcontrib>STEINER, Melita</creatorcontrib><creatorcontrib>STEINER, Ladislau</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CHUN PO YEN</au><au>VARADY, Peter</au><au>SHEEHAN, Jason</au><au>STEINER, Melita</au><au>STEINER, Ladislau</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery</atitle><jtitle>Journal of neurosurgery</jtitle><addtitle>J Neurosurg</addtitle><date>2007-03-01</date><risdate>2007</risdate><volume>106</volume><issue>3</issue><spage>361</spage><epage>369</epage><pages>361-369</pages><issn>0022-3085</issn><eissn>1933-0693</eissn><coden>JONSAC</coden><abstract>Subtotal obliteration of cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS) implies a complete angiographic disappearance of the AVM nidus but persistence of an early filling draining vein, indicating that residual shunting is still present; hence, per definition there is still a patent AVM and the risk of bleeding is not eliminated. The aim of this study was to determine the risk of hemorrhage for patients with subtotal obliteration of AVMs.
After GKS for cerebral AVMs, follow-up angiography demonstrated a subtotally obliterated lesion in 159 patients. Of these, in 16 patients a subtotally obliterated AVM developed after a second GKS was performed for the partially obliterated lesion. The mean age of these patients was 35.2 years at the time of the diagnosis of subtotally obliterated AVMs. The lesion volumes at the time of initial GKS treatment ranged from 0.1 to 11.5 cm3 (mean 2.5 cm3). The mean peripheral dose used in the 175 GKS treatments was 22.5 Gy (median 23 Gy, range 15-31 Gy). To achieve total obliteration of the AVM, 23 patients underwent a new GKS targeting the proximal end of the early filling vein. The mean peripheral dose given in these cases was 23 Gy (median 24, range 18-25 Gy). The incidence of subtotally obliterated AVMs was 7.6% from a total of 2093 AVMs treated and in which follow-up imaging was available. The diagnosis of subtotally obliterated AVMs was made a mean of 29.4 months (range 4-178 months) after GKS. The number of patient-years at risk (from the time of the diagnosis of subtotally obliterated AVMs until either the confirmation of a total obliteration of the lesion on angiography or the time of the latest follow-up angiographic study that still visualized the early filling vein) was a mean of 3.9 years, ranging from 0.5 to 13.5 years, and a total of 601 patient-years. There was no case of bleeding after the diagnosis of subtotally obliterated AVMs. Of 90 patients who did not undergo further treatment and in whom follow-up angiography studies were available, the same early filling veins still filled in 24 (26.7%), and the subtotally obliterated AVMs were subsequently obliterated in 66 patients (73.3%). In 19 patients who underwent repeated GKS for subtotally obliterated AVMs and in whom follow-up angiography studies were available, the AVMs were obliterated in 15 (78.9%) and remained patent in four (21.1%).
The fact that none of the patients with subtotally obliterated AVMs suffered a rupture is not compatible with the assumption of an unchanged risk of hemorrhage for these lesions, and implies that the protection from rebleeding in patients with subtotal obliteration is significant. Subtotal obliteration does not necessarily seem to be a stage of an ongoing obliteration. At least in some cases it represents an end point of this process, with no subsequent obliteration occurring. This observation requires further confirmation by open-ended follow-up imaging.</abstract><cop>Park Ridge, IL</cop><pub>American Association of Neurological Surgeons</pub><pmid>17367056</pmid><doi>10.3171/jns.2007.106.3.361</doi><tpages>9</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Biological and medical sciences Cerebral Hemorrhage - etiology Child Female Follow-Up Studies Humans Intracranial Arteriovenous Malformations - complications Intracranial Arteriovenous Malformations - diagnostic imaging Intracranial Arteriovenous Malformations - surgery Male Medical sciences Middle Aged Neurosurgery Radiography Radiosurgery Retreatment Retrospective Studies Risk Assessment Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Treatment Outcome |
| title | Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery |
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