Long-term outcomes of stereotactic radiosurgery for arteriovenous malformations in the thalamus

Tomoyuki Koga, Masahiro Shin, Keisuke Maruyama, Atsuro Terahara, Nobuhito Saito

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

BACKGROUND: Arteriovenous malformations (AVMs) in the thalamus carry a high risk of hemorrhage. Although stereotactic radiosurgery (SRS) is widely accepted because of the high surgical morbidity and mortality of these lesions, precise long-term outcomes are largely unknown. OBJECTIVE: To review our experience with SRS for thalamic AVMs based on the latest follow-up data. METHODS: Forty-eight patients with thalamic AVMs were treated by SRS using the Leksell Gamma Knife and were followed. Long-term outcomes including the obliteration rate, hemorrhage after treatment, and adverse effects were retrospectively analyzed. RESULTS: The annual hemorrhage rate before SRS was 14%. The mean follow-up period after SRS was 66 months (range 6-198 months). The actuarial obliteration rate confirmed by angiography was 82% at 5 years after treatment, and the annual hemorrhage rate after SRS was 0.36%. Factors associated with higher obliteration rates were previous hemorrhage (P = .004) and treatment using new planning software (P = .001). Persistent worsening of neurological symptoms was observed in 17% and more frequently seen in patients who were treated using older planning software (P = .04) and a higher margin dose (P = .02). The morbidity rate for patients who received treatment planned using new software with a margin dose not more than 20 Gy was 12%. CONCLUSION: SRS for thalamic AVMs achieved a high obliteration rate and effectively decreased the risk of hemorrhage, with less morbidity compared with other modalities. Longer follow-up to evaluate the risk of delayed complications and the effort to minimize the morbidity is necessary.

Original languageEnglish (US)
Pages (from-to)398-403
Number of pages6
JournalNeurosurgery
Volume67
Issue number2
DOIs
StatePublished - Aug 1 2010
Externally publishedYes

Keywords

  • Arteriovenous malformation
  • Gamma knife
  • Stereotactic radiosurgery
  • Thalamus

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