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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2002 June;46(2):43-54

language: English

Arteriovenous mal­for­ma­tions in the ­basal gan­glia ­region: Gamma Knife radio­sur­gery as ­first ­choice treat­ment in select­ed cas­es

Crocco A.

Department of Neurosurgery, University Hospital, Verona


Background. The authors ­report the ­results of Gamma Knife (GK) radio­sur­gery on a clin­i­cal ­series of select­ed ­patients ­with ­brain ­basal gan­glia arter­i­ov­e­nous mal­for­ma­tions (BG AVMs). Furthermore, clin­i­co-epi­dem­i­olog­i­cal and ana­to­mo-func­tion­al pic­tures of BG AVMs and supra­ten­to­ri­al cor­ti­cal AVMs are com­par­a­tive­ly anal­ized, and ­their influ­ence on the radio­sur­gi­cal out­come is dis­cussed.
Methods. At our Department, 33 BG AVMs (21 ­with FU >2 ­years) and 209 cor­ti­cal AVMs (110 ­with FU >2 ­years) ­with a radio­sur­gi­cal vol­ume 10 cc under­went GK ­from February 1993 to July 2001. Mean age, ­male/­female ­ratio (M/F), and bleed­ing ­rate at clin­i­cal ­onset in the 2 sub­groups of ­patients ­were as fol­lows: 25.5 ­years (5-62 ­years), 16 M/17 F, and 30/33 (91%) in BG AVMs, respec­tive­ly; 34.4 ­years (8-74 ­years), 124 M/85 F, and 107/209 (51%) in cor­ti­cal AVMs, respec­tive­ly. Statistical anal­y­sis per­formed ­with con­tin­gen­cy ­table meth­od and devi­ance anal­y­sis accord­ing to gen­er­al­ized lin­e­ar mod­els ­showed ­that the dif­fer­enc­es con­cern­ing age at ­onset and bleed­ing ­rate ­were high­ly sig­nif­i­cant.
Results. The ­rates of com­plete oblit­er­a­tion, per­ma­nent mor­bid­ity, bleed­ing/rebleed­ing dur­ing laten­cy peri­od, and unsuc­cess­ful embol­iza­tion ­attempt in the 2 sub­groups of ­patients ­were as fol­lows: 81%, 4%, 8%, and 41.7% in BG AVMs, respec­tive­ly; 85.5%, 2%, 2%, and 2% in cor­ti­cal AVMs, respec­tive­ly.
Conclusions. In our expe­ri­ence, the dif­fer­ent clin­i­co-epi­dem­i­olog­i­cal and ana­to­mo-func­tion­al char­ac­ter­is­tics ­between BG AVMs and cor­ti­cal AVMs do not ­seem to influ­ence the radio­sur­gi­cal out­come as com­plete oblit­er­a­tion and per­ma­nent neu­ro­log­i­cal seque­lae ­rates are ­very sim­i­lar in ­these 2 sub­groups of ­patients. GK radio­sur­gery may be con­sid­ered the ­first ­choice treat­ment modal­ity in BG AVMs ­with <10 cc vol­ume (­very ­high ­cure ­rate, ­very low per­ma­nent mor­bid­ity, and ­zero mor­tal­ity). Although the haem­or­rhag­ic ­onset in BG AVMs is ­much ­more fre­quent ­than in cor­ti­cal AVMs, the dif­fer­ence in the bleed­ing/rebleed­ing ­rate ­between the 2 sub­groups of ­patients dur­ing the laten­cy peri­od is not sta­tis­ti­cal­ly sig­nif­i­cant and ­this occur­ence ­seems to be lim­it­ed with­in the ­first ­year ­after GK.

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