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Titre du document / Document title

Radiosurgery for basal ganglia, internal capsule, and thalamus arteriovenous malformation: Clinical outcome. Commentary

Auteur(s) / Author(s)

ANDRADE-SOUZA Yuri M. (1) ; ZADEH Gelareh (1) ; SCORA Daryl (2) ; TSAO May N. (3) ; SCHWARTZ Michael L. (1) ; KONDZIOLKA Douglas ; POLLOCK Bruce E. ; STEINBERG Gary K. ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Division of Neurosurgery, Sunnybrook and Women's College, Health Science Centre, University of Toronto, Toronto, Ontario, CANADA
(2) Department of Medical Physics, Department of Radiation Oncology, Sunnybrook and Women's College, Health Science Centre, University of Toronto, Toronto, Ontario, CANADA
(3) Department of Radiation Oncology, Sunnybrook and Women's College, Health Science Centre, University of Toronto, Toronto, Ontario, CANADA

Résumé / Abstract

OBJECTIVE: Radiosurgery is accepted as the first option for treating deep arteriovenous malformations (AVMs), although the clinical outcome in this subgroup of brain AVMs is not well studied. The objective of this study is to review our experience with radiosurgical treatment for these AVMs. METHODS: Between October 1989 and December 2000, 45 patients with depp AVMs (including basal ganglia, internal capsule, and thalamus) underwent stereotactic radiosurgery. Three patients were lost to follow-up and therefore were excluded from this study. Patient characteristics and outcomes were collected and analyzed. The obliteration prediction index and the radiosurgery-based AVM score were calculated and tested. RESULTS: Forty-two patients were followed up for a median of 39 months (range, 25-90 mo; mean, 45.8 mo). The median maximum AVM diameter during the radiosurgery was 1.8 cm (range, 0.9-4.0 cm; mean, 2.07 cm), and the median AVM volume was 2.8 cm3(range, 0.2-18.3 cm3; mean, 4.74 cm3. The mean marginal dose was 16.2 Gy (mean, 15 Gy), and the median maximum dose was 22.4 Gy (range, 16.6-30 Gy). The AVM cure rate after the first radiosurgical treatment, using angiography- and magnetic resonance imaging-confirmed obliteration, was 61.9%. The predicted obliteration using the obliteration prediction index was 60%. Eight patients patients (7.1%) and permanent in five patients (11.9%). The risk of postradiosurgical hemorrhage in this cohort was 9.5% for the first year, 4.7% for the second achieved in 70% of the patients in the group with radiosurgery-based AVM score less than 1.5 compared with 40.9% in the group with radiosurgery-based ABM score greater thant 1.5% (P = 0.059). CONCLUSION: Radiosurgery for deep AVMs has a satisfactory obliteration, rate and acceptable morbidity, considering the risk of hemorrhage without tratment and the risk of morbidity associated with other treatment modalities.

Revue / Journal Title

Neurosurgery    ISSN  0148-396X   CODEN NRSRDY 

Source / Source

2005, vol. 56, no1, pp. 56-64 [9 page(s) (article)] (51 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1977) (Revue)

Mots-clés anglais / English Keywords

Central nervous system disease

;

Cerebral disorder

;

Cerebrovascular disease

;

Vascular disease

;

Congenital disease

;

Cardiovascular disease

;

Stereotaxia

;

Clinical management

;

Linear accelerator

;

Stroke

;

Prognosis

;

Thalamus

;

Intracranial arteriovenous malformation

;

Internal capsule

;

Basal ganglion

;

Arteriovenous malformation

;

Radiosurgery

;

Surgery

;

Nervous system diseases

;

Mots-clés français / French Keywords

Système nerveux central pathologie

;

Encéphale pathologie

;

Cérébrovasculaire pathologie

;

Vaisseau sanguin pathologie

;

Maladie congénitale

;

Appareil circulatoire pathologie

;

Stéréotaxie

;

Conduite à tenir

;

Accélérateur linéaire

;

Accident cérébrovasculaire

;

Pronostic

;

Thalamus

;

Malformation artérioveineuse intracrânienne

;

Capsule interne

;

Noyau gris central

;

Malformation artérioveineuse

;

Radiochirurgie

;

Chirurgie

;

Système nerveux pathologie

;

Mots-clés espagnols / Spanish Keywords

Sistema nervosio central patología

;

Encéfalo patología

;

Vaso sanguíneo encéfalo patología

;

Vaso sanguíneo patología

;

Enfermedad congénita

;

Aparato circulatorio patología

;

Estereotaxia

;

Actitud médica

;

Acelerador lineal

;

Accidente cerebrovascular

;

Pronóstico

;

Tálamo

;

Malformación arteriovenosa intracraneal

;

Cápsula interna

;

Núcleo basal

;

Malformación arteriovenosa

;

Radiocirugía

;

Cirugía

;

Sistema nervioso patología

;

Mots-clés d'auteur / Author Keywords

Basal ganglia

;

Deep brain arteriovenous malformation

;

Linear accelerator

;

Management

;

Stereotactic radiosurgery

;

Stroke

;

Thalamus

;

Localisation / Location

INIST-CNRS, Cote INIST : 18396, 35400012645678.0070

Nº notice refdoc (ud4) : 16392406



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