Author/Authors :
Badr, Mohamed Gamma Knife Center, Egypt , El-Shehaby, Amr Gamma Knife Center, Egypt , El-Shehaby, Amr Ain Shams University - Department of Neurosurgery, Egypt , Saoud, Khaled Ain Shams University - Department of Neurosurgery, Egypt , Abdelkarim, Khaled Gamma Knife Center, Egypt , Abdelkarim, Khaled Ain Shams University - Department of Clinical Oncology, Egypt , Reda, Wael A Gamma Knife Center, Egypt , Reda, Wael A Ain Shams University - Department of Neurosurgery, Egypt
Abstract :
Background: The goal of stereotactic radiosurgery for cerebral arteriovenous malformations (AVMs) is to obliterate the AVM nidus, decrease the risk of future hemorrhage, and improve seizure severity,headache, or other neurological deficits. Objectives: evaluation of gamma knife radiosurgery as amodality of treatment of intracranial arteriovenous malformation. Patients and Methods: this study was conducted on 108 patients of intracranial AVMs between 2002 and 2010. All cases of AVMs were included in the study with exception of those had previous conventional radiotherapy for theirintracranial AVMs or those with AVMs requiring staged volume treatment. Results: Completeobliteration of AVMs was documented by MR imaging and cerebral angiography in 94 patients (87%). Only 5 patients (4.6%) showed bleeding from their treated AVMs. Permanent residual deficit was observed in 4 of the 5 patients with hemorrhage. In 23 patients (21.3%), symptomatic adverse radiation effects (AREs) (edema) developed after Gamma knife treatment. In 4 patients (3.7%), a persistent clinical deterioration developed (one of them suffered hemiparesis and 3 patients suffered a visual field defect but no total loss of vision). In the other 19 (17.5%) patients AREs were successfully managed with a short course of corticosteroids. Follow up of patients who presented with seizures showed that 27 patients (67.5%) became seizure free (Engel grade 1), 9 patients (29.7%) had rare seizures (Engel grade 2) and only one patient (2.7%) showed no improvement (Engel grade 4). Conclusion: Gamma knife radiosurgery for AVMs is an effective treatment modality. We were able to treat all patients with both ruptured and unruptured malformations and reached excellent or good clinical outcome in 96% of our patients, with a 87% angiographic obliteration. Larger or deeply located AVMs showed less favourable outcomes in terms of lower obliteration rates and more adverse radiation effects.
