Introduction: Following gamma knife (GK) therapy for intracranial AVM's, obliteration of the nidus occurs over several years. During this period complications like rebleeding have been attributed to early draining vein occlusion.
Objectives: To evaluate if shielding the draining vein(s) during GK prevents early draining vein obliteration and complications following GK
Methods: This was a non-randomized case-control study over 5 years (Jan 2009-Feb 2014) and included patients with intracranial AVM who underwent gamma knife therapy (Leksell Perfexion®, Elekta, Stockholm) at our centre. All patients who underwent draining vein shielding (DVS) by senior author (DA) were included in the test group and patients who did not undergo DVS were put in the control group. Patients were followed up 6 monthly clinically as well as radiologically with CT head/MRI brain to see for PRI changes.
Results: 185 patients were included in this study of which 96 were in the control group and 89 in the test group. Both groups were well matched in demographics, co-morbidities, adjuvant treatment, angio-architecture and radiation dosing. Due to shielding, the test group patients received significantly less radiation to the draining vein than the control group (p = 0.0001). On follow up, significantly less number of patients in the test group had new neurological deficits (p = 0.001), intracranial hemorrhage (p = 0.03) and PRI changes (p = 0.002).
Conclusions: Shielding of draining vein is a potent new strategy in minimizing PRI and hemorrhage as well as clinical deterioration following gamma knife therapy for intracranial AVM's.
Patient Care: Dramatically reduce complications of Gamma Knife in intracranial AVM's using a new technique of draining vein shielding
Learning Objectives: How to reduce complications of Gamma Knife in intracranial AVM's using a new technique of draining vein shielding