Comparison of Single-Session, Neoadjuvant, and Adjuvant Embolization Gamma Knife Radiosurgery for Arteriovenous Malformation
- Authors
- Kim, Myung Ji; Jung, Hyun Ho; Kim, Yong Bae; Chang, Jong Hee; Chang, Jin Woo; Park, Keun Young; Chang, Won Seok
- Issue Date
- May-2023
- Publisher
- Lippincott Williams & Wilkins Ltd.
- Keywords
- Arteriovenous malformation (AVM); Cerebrovascular disease; Embolization; Gamma knife radiosurgery (GKRS); Intracerebral hemorrhage; Intranidal aneurysm; Obliteration; Stereotactic radiosurgery (SRS)
- Citation
- Neurosurgery, v.92, no.5, pp 986 - 997
- Pages
- 12
- Indexed
- SCIE
SCOPUS
- Journal Title
- Neurosurgery
- Volume
- 92
- Number
- 5
- Start Page
- 986
- End Page
- 997
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/62298
- DOI
- 10.1227/neu.0000000000002308
- ISSN
- 0148-396X
1524-4040
- Abstract
- BACKGROUND:
The purpose of intracranial arteriovenous malformations (AVMs) treatment is to prevent bleeding or subsequent hemorrhage with complete obliteration. For large, difficult-to-treat AVMs, multimodal approaches including surgery, endovascular embolization, and gamma knife radiosurgery (GKRS) are frequently used.
OBJECTIVE:
To analyze the outcomes of AVMs treated with single-session, neoadjuvant, and adjuvant embolization GKRS.
METHODS:
We retrospectively reviewed a database of 453 patients with AVMs who underwent GKRS between January 2007 and December 2017 at our facility. The obliteration rate, incidence of latent period bleeding, cyst formation, and radiation-induced changes were compared among the 3 groups, neoadjuvant-embolized, adjuvant-embolized, nonembolized group. In addition, the variables predicting AVM obliteration and complications were investigated.
RESULTS:
A total of 228 patients were enrolled in this study. The neoadjuvant-embolized, adjuvant-embolized, and nonembolized groups comprised 29 (12.7%), 19 (8.3%), and 180 (78.9%) patients, respectively. Significant differences were detected among the 3 groups in the history of previous hemorrhage and the presence of aneurysms (P < .0001). Multivariate Cox regression analyses revealed a significant inverse correlation between neoadjuvant embolization and obliteration occurring 36 months after GKRS (hazard ratio, 0.326; P = .006).
CONCLUSION:
GKRS with either neoadjuvant or adjuvant embolization is a beneficial approach for the treatment of AVMs with highly complex angioarchitectures that are at risk for hemorrhage during the latency period. Embolization before GKRS may be a negative predictive factor for late-stage obliteration (>36 months). To confirm our conclusions, further studies involving a larger number of patients and continuous follow-up are necessary.
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- Appears in
Collections - 2. Clinical Science > Department of Neurosurgery > 1. Journal Articles
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