Microsurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery

スポンサーリンク

概要

• 論文の詳細を見る

• Radiosurgery is effective in obliterating small arteriovenous malformations (AVMs), but less successful in thrombosing larger AVMs. This study reviewed patients who underwent surgical resection of their large AVMs following failed radiosurgical obliteration. AVMs from 36 patients (aged 7 to 64 years, mean 29.9) were surgically resected 1 to 11 years after radiosurgery. Initial AVM volumes were 0.7 to 117cm3 (mean 21.6cm3), and radiosurgical doses ranged from 4.6 to 45 Gray equivalent (GyE) (mean 21.1 GyE). Thirty AVMs (83%) were located in eloquent tissue. Venous drainage was deep (14), superfi-cial (13), or both (9). Spetzler grades were II (2), III (12), IV (18), and V (4). Nine patients suffered re-hemorrhage after radiosurgery but prior to surgery, while three patients developed radiation necrosis. Twenty-seven patients underwent endovascular embolization prior to surgery. During microsurgical resection, the AVMs were found to be significantly less vascular and more easily resected, compared to AVMs in patients who had not received radiosurgery. Histology showed endothelial proliferation with hyaline and mineralization in vessel walls. Partial or complete thrombosis of some AVM vessels, and evidence of vessel and brain necrosis were noted in many cases. Clinical outcome was excellent or good in 34 cases, with two patients dying of rebleeding from residual AVM. Five patients were neurologically worse following microsurgical resection. Final outcome was largely related to the pretreatment grade. Radiosurgery several years prior to surgical resection appears useful in treating unusually large and complex AVMs.

• 社団法人 日本脳神経外科学会の論文

著者

• Steinberg Gary

  Department Of Neurosurgery And Division Of Neuroradiology Stanford University School Of Medicine

• Chang Steven

  Department Of Neurosurgery Ans The Stanford Stroke Center Stanford University Medical Center

• Marks Michael

  Department Of Neurosurgery And Division Of Neuroradiology Stanford University School Of Medicine

• LEVY Richard

  Departments of Neurosurgery, and the Stanford Stroke Center, Stanford University School of Medicine

• STEINBERG Gary

  Departments of Neurosurgery, and the Stanford Stroke Center, Stanford University School of Medicine

• FRANKEL Ken

  Departments of Neurosurgery, and the Stanford Stroke Center, Stanford University School of Medicine

• SHUSTER Deborah

  Departments of Pathology (Neuropathology), and the Stanford Stroke Center, Stanford University School of Medicine

• MARCELLUS Mary

  Departments of Radiology, and the Stanford Stroke Center, Stanford University School of Medicine

• MARKS Michael

  Departments of Neurosurgery, and the Stanford Stroke Center, Stanford University School of Medicine

関連論文

• Lysosome-Related Organelles: a View from Immunity and Pigmentation
• New Strategies for Cerebral Aneurysms : Suegery, Endovascular Surgery, and Hypothermia
• Carotid and Vertebral Rete Mirabile in Man Presenting With Intraparenchymal Hemorrhage : A Case Report
• Neuropsychological recovery from childhood moyamoya disease
• Clinical Experience with Image-guided Robotic Radiosurgery (the Cyberknife) in the Treatment of Brain and Spinal Cord Tumors
• Length of site-specific positive surgical margins as a risk factor for biochemical recurrence following radical prostatectomy
• Editorial Comment to Solitary and small (≤3mm) apical positive surgical margins are related to biochemical recurrence after radical prostatectomy
• Microsurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery

スポンサーリンク