Stereotactic radiosurgery with neoadjuvant embolization of larger arteriovenous malformations: An institutional experience

Authors

Richard Dalyai, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
Thana Theofanis, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
Robert Starke, Department of Neurosurgery, University of VirginiaFollow
Nohra El-Chalouhi, MD, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
George M. Ghobrial MD, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
Pascal Jabbour, MD, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
Aaron Dumont, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
L. Fernando Gonzalez, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
David Gordon, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience
Robert Rosenwasser, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow
Stavropoula Tjoumakaris, Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for NeuroscienceFollow

Document Type

Article

Publication Date

1-22-2014

Comments

This article has been peer reviewed. It was published in: BioMed Research International.

Volume 2014, 2014, Article number 306518

The published version is available at DOI: 10.1155/2014/306518

Copyright © 2014 Richard Dalyai et al.

Abstract

Objective. This study investigates the safety and efficacy of a multimodality approach combining staged endovascular embolizations with subsequent SRS for the management of larger AVMs. Methods. Ninety-five patients with larger AVMs were treated with staged endovascular embolization followed by SRS between 1996 and 2011. Results. The median volume of AVM in this series was 28 cm³ and 47 patients (48%) were Spetzler-Martin grade IV or V. Twenty-seven patients initially presented with hemorrhage. Sixty-one patients underwent multiple embolizations while a single SRS session was performed in 64 patients. The median follow-up after SRS session was 32 months (range 9-136 months). Overall procedural complications occurred in 14 patients. There were 13 minor neurologic complications and 1 major complication (due to embolization) while four patients had posttreatment hemorrhage. Thirty-eight patients (40%) were cured radiographically. The postradiosurgery actuarial rate of obliteration was 45% at 5 years, 56% at 7 years, and 63% at 10 years. In multivariate analysis, larger AVM size, deep venous drainage, and the increasing number of embolization/SRS sessions were negative predictors of obliteration. The number of embolizations correlated positively with the number of stereotactic radiosurgeries (P < 0.005). Conclusions. Multimodality endovascular and radiosurgical approach is an efficacious treatment strategy for large AVM.

Recommended Citation

Dalyai, Richard; Theofanis, Thana; Starke, Robert; El-Chalouhi, MD, Nohra; Ghobrial, George M. MD; Jabbour, MD, Pascal; Dumont, Aaron; Gonzalez, L. Fernando; Gordon, David; Rosenwasser, Robert; and Tjoumakaris, Stavropoula, "Stereotactic radiosurgery with neoadjuvant embolization of larger arteriovenous malformations: An institutional experience" (2014). Department of Neurosurgery Faculty Papers. Paper 54.
https://jdc.jefferson.edu/neurosurgeryfp/54