• World Neurosurg · Feb 2017

    Long-term outcomes of single-session stereotactic radiosurgery for cerebellar arteriovenous malformation, with a median follow up of 10 years.

    • Hirotaka Hasegawa, Shunya Hanakita, Masahiro Shin, Masaaki Shojima, Tomoyuki Koga, Wataru Takahashi, Madoka Sakuramachi, Akihiro K Nomoto, and Nobuhito Saito.
    • Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: hirohasegawa-tky@umin.ac.jp.
    • World Neurosurg. 2017 Feb 1; 98: 314-322.

    ObjectiveCerebellar arteriovenous malformation (C-AVM) is poorly tolerated because of its aggressive natural history. The aim of this study was to delineate long-term outcomes of Gamma Knife stereotactic radiosurgery (GKRS) for C-AVM.MethodsThe outcomes of 45 patients who underwent GKRS for C-AVMs at our institution were retrospectively analyzed. Event-free survival was defined as free from any neurologic deficits caused by AVMs or adverse phenomena from the treatment.ResultsThe median age and follow-up were 41 years (range, 6-77 years) and 120 months (range, 5-291 months), respectively. The median volume and Pollock-Flickinger radiosurgical AVM score were 1.3 cm3 (range, 0.1-8.3 cm3) and 1.26 (range, 0.5-2.06), respectively. Actuarial obliteration rates were 46%, 75%, and 90% at 3, 5, and 6 years, respectively. Multivariate analysis showed that the maximal diameter ≤15 mm (P = 0.021) and margin dose >20 Gy (P = 0.0008) were significantly associated with better obliteration. Four patients experienced posttreatment hemorrhages, and annual hemorrhage rates were 1.9% and 0.30% before and after obliteration, respectively. One patient died because of hemorrhage, whereas the other 3 patients spontaneously recovered. Perifocal edema was confirmed in 8 (16%); however, no symptomatic edema was observed. Overall, neurologic deteriorations were noted in 4 patients; 3 were because of posttreatment hemorrhage, and 1 was because of pretreatment angiography. The event-free survival rates were 96%, 93%, and 93% at 4, 10, and 15 years, respectively.ConclusionsGKRS is a reasonable intervention for C-AVMs. Symptomatic complications are rare, and the long-term outcomes are favorable.Copyright © 2016 Elsevier Inc. All rights reserved.

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