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  • Multimodality Treatment of Arteriovenous Malformations (AVMs) of Basal Ganglia and Thalamus: Factors Affecting Outcome and Obliteration

    Final Number:

    Paritosh Pandey MD; Ciara D. Harraher MD, BSc; Steven D. Chang MD; John Adler MD; Huy M. Do MD; Richard Levy MD; Michael P. Marks MD; Gary K. Steinberg MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Basal ganglia/thalamic AVMs have a worse natural history than superficial AVMs. We describe our experience with multimodality treatment of these AVMs.

    Methods: 116 patients were treated,6 patients without radiological follow-up were excluded. Patients were analyzed with respect to presentation, hemorrhage rates, management, outcome and obliteration.

    Results: 110 patients (58 F, 52 M, 5-74 years) were analyzed. 81 patients (73.6%) presented with hemorrhage. Seventy-eight patients (70.9%) were in good neurological condition (mRS 1-2) pre-treatment. The annual risk of hemorrhage before treatment was 10.3% per patient-year, while it was 5.7% after the start of treatment till obliteration/last follow-up. The maximum size of the nidus ranged from 0.8-8 cm (mean 3.4?1.6 cm). Fifty-four of the AVMs grade 4 or 5. Embolization was performed in 58 patients (130 sessions). Ninety-eight patients (89.1%) had at least one radiosurgery during their treatment (138 XRT sessions). 83 patients had 3-yr radiological follow-up, and 21 (25.3%) had obliteration. Fifty-one surgeries were performed in 34 patients (1.5 surgeries/patient), and 52.9% had obliteration. Follow-up ranged from 3 months-18 years (mean 5.2 years). Seventy-four patients (67.3%) had good mRS (0-2). Ten patients (9.1%) expired during follow-up (9 due to hemorrhage from AVM, 1 unrelated cause). Good preoperative mRS (p<0.001), AVM <3 cm (p<0.001), grade 2 and 3 (p<0.001), females (p=0.04), and absence of repeat hemorrhage (p<0.001) predicted good long-term outcome. Obliteration status was evaluated for 98 patients. 54 patients (55.1%) had obliteration of AVM. AVM size <3 cm and S-M grade 2 and 3 predicted obliteration on univariate analysis. For grade 4 and 5 AVMs, the hemorrhage rate pre-treatment was 10.4% and post-treatment was. 23 patients (42.6%) had good outcome at follow-up, AVM was obliterated in 40.4%% patients.

    Conclusions: Basal ganglia and thalamic AVMs can be managed with multimodality treatment with acceptable morbidity and mortality. The hemorrhage rates following treatment are lower than the natural history of the disease. Though radiosurgery is the mainstay of treatment of the central AVMs, judicious use of embolization and surgery lead to better outcomes and obliteration rates.

    Patient Care: by evaluating thesse parameters 1. Management of basal ganglia/thalamic AVMs 2. Natural history of these AVMs 3. Factors affecting outcome and obliteration We would be better treat these AVMs

    Learning Objectives: 1. Management of basal ganglia/thalamic AVMs 2. Natural history of these AVMs 3. Factors affecting outcome and obliteration


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