Abstract
Because multiple cerebral arteriovenous malformations (AVMs) are extremely rare, little information is available as to stereotactic radiosurgery for multiple AVMs. We present a patient with three cerebral AVMs who underwent one stage gamma knife radiosurgery for all three nidi. Each nidus was covered with a 90% isodose volume and a central dose of 27.8 Gy was used to obtain a marginal dose of 25 Gy. Angiography that was performed 10 months after irradiation demonstrated complete obliteration in one nidus, remarkable shrinkage in another and no significant changes in the other. The patient has experienced neither bleeding nor complications related to irradiation, to date. We consider one of the major benefits of stereotactic radiosurgery to be that multiple intracranial AVMs, if all nidi are sufficiently small (<3 cm), can be treated with a single procedure.
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REFERENCES
Drake CG, Friedman AH, Peerless SJ: Posterior fossa arteriovenous malformations. J Neurosurg 64:1–10, 1986
Fong D, Chan ST: Arteriovenous malformation in children. Childs Nervous System 4:199–203, 1988
Paterson JH, McKissock W: A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. Brain 79:233–66, 1956
Rigamonti D, Spetzler RF, Johnson PC, Drayer BP, Carter LP, Ueda T: Cerebral vascular malformations. Barrow Neurol Inst Q 3:18–27, 1987
Salcman M, Scholtz H, Numaguchi Y: Multiple intracerebral arteriovenous malformations: report of three cases and review of the literature. Surg Neurol 38:121–128, 1992
Schlachter LB, Fleischer AS, Faria MA, Tindal GT: Multifocal intracranial arteriovenous malformations. Neurosurgery 7:440–444, 1980
Tamaki N, Fujita K, Yamashita H: Multiple arteriovenous malformations involving the scalp, dura, retina, cerebrum, and posterior fossa: case report. J Neurosurg 34:95–98, 1971
Yasargil MG: Microneurosurgery, III A, AVM of the Brain, History, Embryology, Pathological Considerations, Hemodynamics, Diagnostic Studies, Microsurgical Anatomy. Stuttgart, Thiem Medical, 1988, pp 165–182
Betti OO, Munari C, Rosler R: Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 24:311–321, 1989
Colombo F, Benedetti A, Pozza F, Marchetti C, Chierego G: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833–840, 1989
Colombo F, Pozza F, Chierego G, Casentini L, De Luca G, Francescon P: Linear accelerator radiosurgery of cerebral arteriovenous malformations: an update. Neurosurgery 34:14–21, 1994
Fabrikant JI, Frankel KA, Phillips MH, Levy RP: Stereotactic heavy charged-particle Bragg peak radiosurgery for intracranial arteriovenous malformations. In Cerebral Vascular Diseases in Children and Adolescents. MSB Edwards, HJ Hoffman (eds). Baltimore, Williams & Wilkins, 1989, pp 389–409
Fabrikant JI, Lyman JT, Hosobuchi Y: Stereotactic heavy-ion Bragg peak radiosurgery for intracranial vascular disorders: Method for treatment of deep arteriovenous malformations. Br J Radiol 57:479–490, 1984
Friedman WA, Bova FJ: Linear accelerator radiosurgery for arteriovenous malformations. J Neurosurg 77:832–841, 1992
Friedman WA, Bova FJ, Mendenhall WM: Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. J Neurosurg 82:180–189, 1995
Jimbo M, Kitamura K, Steiner L: Radiotherapy to cerebral arteriovenous malformation. In Neurosurgeons, vol. 6 (Proceedings of the 7th Annual Meeting of the Japanese Congress of Neurological Surgeons). K Hirakawa (ed). Tokyo, Scimed Publications, 1987, pp 254–257 (in Japanese, English abstract)
Kawamoto S: Radiosurgery of arteriovenous malformations. No-Shinkei-Geka (Neurol Surg, Tokyo) 22:403–420, 1994 (in Japanese)
Kjellberg RN, Hanamura T, Davis KR, Lyons SL, Adams RD: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269–274, 1983
Levy RP, Fabrikant JI, Frankel KA, Phillips MH, Lyman JT: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841–852, 1989
Lindquist C, Steiner L: Stereotactic radiosurgical treatment of arteriovenous malformations. In Modern Stereotactic Neurosurgery. LD Lunsford (ed). Boston, Nijhoff, 1988, pp 491–505
Loeffler JS, Rossitch E Jr, Siddon R, Moore MR, Rockoff MA, Alexander E III: Role of stereotactic radiosurgery with a linear accelerator in treatment of intracranial arteriovenous malformations and tumors in children. Pediatrics 85:774–784, 1990
Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Jungreis CA, Maitz AH: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512–524, 1991
Pollock BE, Lunsford LD, Kondziolka D, Maitz A, Flickinger JC: Patient outcomes after stereotactic radiosurgery for “operable” arteriovenous malformations. Neurosurgery 35:1–8, 1994
Souhami L, Olivier A, Podgorsak EB, Pla M, Pike GB: Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiatl Oncol Biol Phys 19:775–782, 1990
Steinberg GK, Fabrikant JI, Marks MP, Levy RP, Frankel KA, Phillips MH, et al: Stereotactic heavy-charged particle Bragg peak radiation for intracranial arteriovenous malformations. N Engl J Med 323:96–101, 1990
Steiner L: Treatment of arteriovenous malformation by radiosurgery. In Intracranial Arteriovenous Malformations. CB Wilson, BM Stein (eds.). Baltimore, Williams & Wilkins, 1984, pp 295–313
Steiner L, Lindquist C, Adler JR, Torner JC, Alves W, Steiner M: Clinical outcome of radiosurgery for cerebral arteriovenous malformations. J Neurosurg 77:1–8, 1992
Steiner L, Lindquist C, Steiner M: Radiosurgery. In Advances and Technical Standards in Neurosurgery. L Symon (ed.). Wien, Springer-Verlag, 1992, pp 19–102
Yamamoto Y, Coffey RJ, Nichols DA, Shaw EG: Interim report on the radiosurgical treatment of cerebral arteriovenous malformations: the influence of size, dose, time and technical factors on obliteration rate. J Neurosurg 83:832–837, 1995
Yamamoto M, Ide M, Jimbo M, Aiba M, Ito M, Hirai H, et al: Gamma knife radiosurgery with numerous target points for intracranially disseminated metastases: early experience in three patients and experimental analysis of whole brain irradiation doses. In Radiosurgery 1997. D Kondziolka (ed.). Basel, Karger, 1998
Ericson K, Söderman M, Karlsson B, Lindquist C: Multiple intracranial arteriovenous malformations: a case report. Neuroradiology 36:157–159, 1994
Kikuchi K, Kowada M, Tomura N, Johkura H: Hereditary hemorrhagic teleangiectasia associated with cerebral arteriovenous fistula and multiple cerebral arteriovenous malformations: case report. No-Shinkei-Geka (Neurosurgery, Tokyo) 22:85–91, 1994 (in Japanese, English abstract)
Yamamoto M, Jimbo M, Hara M, Saito I, Mori K: Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than five years after irradiation. Neurosurgery 38:906–914, 1996
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Yamamoto, M., Ide, M., Jimbo, M. et al. Angiographic Follow-up of One-Stage Radiosurgery for Multiple Cerebral Arteriovenous Malformations. Journal of Radiosurgery 1, 213–221 (1998). https://doi.org/10.1023/B:JORA.0000015196.57676.6e
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DOI: https://doi.org/10.1023/B:JORA.0000015196.57676.6e