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Contemporary management of large-volume arteriovenous malformations: a clinician’s review

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Journal of Radiation Oncology

Abstract

Arteriovenous malformations (AVMs) represent a heterogeneous group of lesions, and as such, there exist several treatment options and approaches depending on size, location, grading, and symptoms. Large-volume AVMs represent a particularly challenging subset of AVMs with controversy over the very classification with definitions based on size, volume, and Spetzler-Martin grade. With regards to treatment paradigms, the natural history of these lesions is an important foundation upon which management principles have been built. At this time, management options range from observation with medical management to interventions including radiosurgery, microsurgery, embolization, or a combination of these approaches. In light of the challenges facing clinicians, we performed a literature review of AVMs with a specific focus on the management of large-volume AVMs with respect to outcomes, toxicity, and future treatment options. Based on the review, we have proposed a comprehensive risk-based treatment algorithm for the management of large-volume AVMs.

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Authors and Affiliations

  1. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Nikhil P. Joshi, Chirag Shah, Rupesh Kotecha, Erin S. Murphy, Samuel T. Chao & John H. Suh

  2. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Erin S. Murphy, Samuel T. Chao & John H. Suh

  3. Department of Neurosurgery, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Peter A. Rasmussen

Authors
  1. Nikhil P. Joshi
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  2. Chirag Shah
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  3. Rupesh Kotecha
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  4. Erin S. Murphy
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  5. Samuel T. Chao
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  7. John H. Suh
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Corresponding author

Correspondence to John H. Suh.

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Conflicts of interest

John Suh is a consultant of Varian Medical Systems. Samuel Chao is on the Speaker’s Bureau Varian Medical Systems. Peter Rasmussen is an investor and on the Scientific Advisory Board for Blockade Medical, is a Scientific Advisory Board for Covidien/Medtronic, is on the Scientific Advisory Board, is a Stock Holder in Perflow Medical, and is on the Scientific Advisory Board for Stryker Neurovascular. Nikhil Joshi declares that he has no conflict of interest. Chirag Shah declares that he has no conflict of interest. Rupesh Kotecha declares that he has no conflict of interest. Erin Murphy declares that she has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any other authors.

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Joshi, N.P., Shah, C., Kotecha, R. et al. Contemporary management of large-volume arteriovenous malformations: a clinician’s review. J Radiat Oncol 5, 239–248 (2016). https://doi.org/10.1007/s13566-016-0261-8

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  • DOI: https://doi.org/10.1007/s13566-016-0261-8

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