Introduction: Cerebral arteriovenousmalformation(AVM) is a congenital vascular anomaly with vessel tangle which directly shunts blood from arterial in put to the venous system without an intervening capillary network to decrease pressure.Major risk is rupture which has 10%mortality and 30–50%morbidity from each bleed.Stereotactic radiosurgery has proven effect on small and middle size AVM’s.We aim to report our experience on cerebralAVM’s which were treated by GammaKnife
Methods: Between2005and2015,717 patients with AVMs were treated with GKS at Gamma Knife Center of Gazi University Hospital Neurosurgery Department.We analyzed 311 adult patients who has at least two year regular follow-up. The rest of the patients are either children or lost in follow-up or have less than 2 years follow-up. Three patients died from other causes.The median follow-up was 75,2months( 36-108months).Total AVM obliteration is determined angiographically.Many factors including theage, sex, AVM volume, the dose,radiosurgery based AVM grading, priorembolization, priorbleed, obliteration rates, complications, hemorrhage risk after treatment were analysed.The relation between the AVM features and obliteration rates were also analysed
Results: There were 105woman(33,7%)and 206man(66.2%).The median age was 36.6(18-67)The median nidus volume treated was 6877.2 mm³.90 patients had ruptured AVM’S(28.9%)and 221patients had unruptured AVM’s(71.1%).108Patients had previous embolization(34.7%),where as203 patients were treated with only stereotacticradiosurgery.The mediandose was20.7(12-25)Gy.Obliteration rate was 72.3% (225 of 311patients). In embolized patients obliteration rates is 74% (80 of 108 patients).The obliteration rate in unembolized patients is 71% (145 of 203).The median interval to achieve total obliteration was 27.6 (9-67)months.At 7 patients(2.25%)intracranial hemorrhage occured during follow up period.The complication rate was 0.96%including edema,optic neuropathy.7patients died from bleeding during the follow up and none of them had obliterated AVM.
Conclusions: Stereotactic radiosurgery is safe and effective treatment modality forGrade 1,2and3 AVMs.The obliteration rate is slightly higher in cases with prior embolization than the unembolized patients in thisseries.The combination of the endovascular treatment and stereotactic radiosurgery provides good outcome in cerebralAVM’s.
Patient Care: Hemorrhage of AVMs is major mortalrisc factor.Stereotactic radiosurgery is effective for oblitaration of lesions .For this reason GSR is both non-ınvasive and effective treatment modality.
Learning Objectives: Stereotactic radiosurgery effect on treatment for Grade 1, 2 and 3 AVMs