In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Brain arteriovenous malformations: the impact of associated nidal lesions in outcome after radiosurgery with or without embolization.

    Final Number:
    4071

    Authors:
    Carlos Michel Albuquerque Peres MD; Leonardo Welling PhD; Evandro Cesar de Souza; Manoel Teixeira; Eberval G. Figueiredo MD, PhD; Jose G. Caldas MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: Radiosurgery is an option to treat arteriovenous malformations. The benefits of pre-radiosurgical embolization have not been well established in the treatment of this entity.

    Methods: A longitudinal cohort of 47 consecutive patients who underwent radiosurgery with or without previous embolization were analyzed. Radiosurgery was delivered either as a single or divided in up to 5 equal fractions. Embolizations were performed exclusively with n-butyl cyanoacrylate. The follow up was obtained for 36 months at least. Presence of nidal lesions, such as aneurysms, venous outflow ectasias venous outflow stenosis, and/or intranidal arteriovenous fistulas were evaluated, and their relation with outcome and complications were studied.

    Results: Hemorrhagic event occurred in 68.1% of patients; of these, 62.5 % demonstrated intranidal arteriovenous fistulas, 83.3% had venous ectasias and 90% had venous outflow stenosis. Occlusion rate of embolization plus radiosurgery was 46.1% and SRS alone was 52.4% (p = .671). Variables significantly associated with obliteration were l lack of intranidal arteriovenous fistula, lower nidus volume, higher SRS dose and lower radiosurgical based AVM scale score.

    Conclusions: An untreated arteriovenous fistula inside the AVM at the moment of SRS was associated with lower cure rates (p = .001). Embolization followed by radiosurgery was not superior to radiosurgery alone, although targeted embolization of intranidal arteriovenous fistulae in order to increase obliteration rates and to protect the patient from bleeding during the radiosurgery latency period should be considered.

    Patient Care: Describing that targeted embolization of intranidal arteriovenous fistulae in order to increase obliteration rates and to protect the patient from bleeding during the radiosurgery latency period should be considered.

    Learning Objectives: To demonstrate the possible benefits of pre-radiosurgical embolization of AVMs

    References: Peres CMA, Cesar de Souza E, Teixeira MJ, Figueiredo EG, Caldas JGMP. The impact of associated nidal lesions in outcome of brain arteriovenous malformations after radiosurgery with or without embolization. World Neurosurg. 2017 Jun 15.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy