Abstract
Cerebral arteriovenous malformations (AVMs) frequently arise in the younger population and can cause severe disabilities or death [1–3]. Intracranial hemorrhage is the most common clinical presentation, and annual hemorrhage rate is reported to be 2 to 4% during the natural course of the disease [3–9]. Various treatments have been developed in an attempt to reduce the risk of hemorrhage. Stereotactic radiosurgery, in particular, has been widely used as one of the minimally invasive therapies during the past two decades [1–3,10–13]. It provides an angiographic cure in 80 to 95 percent of patients with a latency period of 3 to 5 years [1,14–17]. A lot of relevant studies have been reported to date all over the world. Recently, however, a lot of new facts were clarified by our up-to-date long-term follow-up study after stereotactic radiosurgery using a gamma knife (Elekta instruments, Norcross, GA, U.S.A.) during the past 15 years. Hereby we introduce several recent advances in both knowledge and technique.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Fleetwood IG, Steinberg GK (2002) Arteriovenous malformations. Lancet 359:863–873
Ogilvy CS, Stieg PE, Awad I, et al (2001) AHA Scientific Statement: Recommendations for the management of intracranial arteriovenous malformations: A statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Stroke 32:1458–1471
The Arteriovenous Malformation Study Group (1999) Arteriovenous malformations of the brain in adults. N Engl J Med 340:1812–1818
Graf CJ, Perret GE, Torner JC (1983) Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331–337
Itoyama Y, Uemura S, Ushio Y, et al (1989) Natural course of unoperated intracranial arteriovenous malformations: Study of 50 cases. J Neurosurg 71:805–809
Brown RD Jr, Wiebers DO, Forbes G, et al (1988) The natural history of unruptured intracranial arteriovenous malformations. Neurosurg 68:352–357
Brown RD Jr, Wiebers DO, Torner JC, et al (1996) Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: A population-based study of intracranial vascular malformations in Olmsted County, Minnesota. J Neurosurg 85:29–32
Crawford PM, West CR, Chadwick DW, et al (1986) Arteriovenous malformations of the brain: Natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:1–10
Ondra SL, Troupp H, George ED, et al (1990) The natural history of symptomatic arteriovenous malformations of the brain: A 24-year follow-up assessment. J Neurosurg 73:387–391
Steinberg GK, Fabrikant JI, Marks MP, et al (1990) Stereotactic heavy-charged-particle Bragg-peak radiation for intracranial arteriovenous malformations. N Engl J Med 323:96–101
Lunsford LD, Kondziolka D, Flickinger JC, et al (1991) Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512–524
Steiner L, Lindquist C, Adler JR, et al (1992) Clinical outcome of radiosurgery for cerebral arteriovenous malformations. J Neurosurg 77:1–8
Maruyama K, Niranjan A, Kondziolka D, et al (2004) Stereotactic radiosurgery for brainstem arteriovenous malformations: Factors affecting outcomes. J Neurosurg 100:401–407
Shin M, Kawamoto S, Kurita H, et al (2002) Retrospective analysis of a 10-year experience of stereotactic radiosurgery for arteriovenous malformations in children and adolescents. J Neurosurg 97:779–784
Karlsson B, Lindquist C, Steiner L (1997) Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425–431
Colombo F, Pozza F, Chierego G, et al (1994) Linear accelerator radiosurgery of cerebral arteriovenous malformations: An update. Neurosurgery 34:14–21
Friedman WA, Bova FJ, Mendenhall WM (1995) Linear accelerator radiosurgery for arteriovenous malformations: The relationship of size to outcome. J Neurosurg 82:180–189
Shin M, Maruyama K, Kurita H, et al (2004) Analysis of nidus obliteration rates after gamma knife surgery for arteriovenous malformations based on long-term follow-up data: The University of Tokyo experience. J Neurosurg 101:18–24
Karlsson B, Lindquist C, Steiner L (1996) Effect of Gamma Knife surgery on the risk of rupture prior to AVM obliteration. Minim Invasive Neurosurg 39:21–27
Levy RP, Fabrikant JI, Frankel KA, et al (1989) Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841–852
Pollock BE, Flickinger JC, Lunsford LD, et al (1996) Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 38:652–661
Friedman WA, Blatt DL, Bova FJ, et al (1996) The risk of hemorrhage after radiosurgery for arteriovenous malformations. J Neurosurg 84:912–919
Fabrikant JI, Levy RP, Steinberg GK, et al (1992) Charged-particle radiosurgery for intracranial vascular malformations. Neurosurg Clin N Am 3:99–139
Guo WY, Karlsson B, Ericson K, et al (1993) Even the smallest remnant of an AVM constitutes a risk of further bleeding. Case report. Acta Neurochir (Wien) 121:212–215
Maruyama K, Kawahara N, Shin M, et al (2005) The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations. N Engl J Med 352:146–153
Fults D, Kelly DL Jr (1984) Natural history of arteriovenous malformations of the brain: A clinical study. Neurosurgery 15:658–662
Mast H, Young W, Koennecke H, et al (1997) Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 350:1065–1068
Schneider BF, Eberhard DA, Steiner LE (1997) Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 87:352–357
Phillips T (1991) Early and late effects of radiation on normal tissues. In: Gutin P, Leibel S, Sheline G (eds) Radiation injury to the nervous system. Raven Press, New York, pp 37–55
Chang SD, Shuster DL, Steinberg GK, et al (1997) Stereotactic radiosurgery of arteriovenous malformations: Pathologic changes in resected tissue. Clin Neuropathol 16:111–116
Lindquist C, Steiner L (1988) Stereotactic radiosurgical treatment of arteriovenous malformations. In: Lunsford L (ed.) Modern Stereotactic Neurosurgery. Martinus Nijhoff Publishing, Boston, pp 491–505
Shin M, Kawahara N, Maruyama K, et al (2005) Risk of hemorrhage from an arteriovenous malformation confirmed to have been obliterated on angiography after stereotactic radiosurgery. J Neurosurg 102:842–846
Yamamoto M, Jimbo M, Kobayashi M, et al (1992) Long-term results of radiosurgery for arteriovenous malformation: Neurodiagnostic imaging and histological studies of angiographically confirmed nidus obliteration. Surg Neurol 37:219–230
Maruyama K, Kamada K, Shin M, et al (2005) Integration of three-dimensional corticospinal tractography into treatment planning for gamma knife surgery. J Neurosurg 102:673–677
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Springer-Verlag Tokyo
About this paper
Cite this paper
Maruyama, K., Shin, M., Kirino, T. (2006). Recent Advances in Radiosurgery for Cerebral Arteriovenous Malformations: The University of Tokyo Experience. In: Kanno, T., Kato, Y. (eds) Minimally Invasive Neurosurgery and Multidisciplinary Neurotraumatology. Springer, Tokyo. https://doi.org/10.1007/4-431-28576-8_5
Download citation
DOI: https://doi.org/10.1007/4-431-28576-8_5
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-28551-9
Online ISBN: 978-4-431-28576-2
eBook Packages: MedicineMedicine (R0)