Analysis of the time course of AVM nidus shrinkage and obliteration showed that most of the radiosurgically induced effect had occurred by 36 months after treatment. Thirty-two (74.4%) of 43 AVMs with volumes of 10 cm ³ or less and six (75%) of eight larger AVMs (volume 11–30 cm ³ ) showed complete obliteration. Fifty-one patients underwent follow-up angiography between 1 and 3 years after treatment, and complete obliteration of the nidus was confirmed in 38 (74.5%) of these patients. The radiosurgical dose to the margin of the nidus was 20 Gy for lesions less than 2.0 cm in diameter (volume ≤ 4.2 cm ³ ) 18 Gy for malformations 2.1 to 3.0 cm in diameter (volume 4.2–14.1 cm ³ ) and 16 Gy for malformations greater than 3.0 cm (volume > 14.1 cm ³ ). Other angiographic features in incompletely obliterated cases were a significant reduction of flow velocity through the malformation together with a reduction in diameter of both feeding arteries and draining veins.ĭuring the authors' initial 4-year experience with radiosurgery using the Leksell cobalt-60 gamma unit, they treated 121 patients with cerebral arteriovenous malformations (AVMs). In 26 patients complete obliteration of the malformation was demonstrated (52%), in 12 patients subtotal obliteration was obtained (24%), in 11 patients the obliteration was evident but not significant (22%), and in 1 patient the AVM was unchanged. Of 56 patients who were followed longer than 1 year, 50 underwent 12-month follow-up angiography. Four instances of minor rebleeding were observed after treatment 3 patients complained of transient neurological deterioration. Mean follow-up is 17.1 months (from 1 to 49). Doses from 18.7 to 40 Gy were delivered in one or two sessions. Lesion dimensions varied from 4 to 40 mm in diameter. Stereotactic localization was performed by stereotactic angiography. In 14 patients, epilepsy was the principal complaint. Four patients had progressive neurological symptoms. Seventy-nine patients suffered one or more than one hemorrhage. From November 1984 to October 1988, 97 patients with cerebral arteriovenous malformations have been treated. The technique is based on multiple intersecting arc irradiations focused on a stereotactic target. Conclusions: The radiosurgery as a therapeutic modality on the treatment of brain arteriovenous malformations are highly effective, with minimum mobility an none mortality associated to the procedure.Ī technique for linear accelerator radiosurgery has been used in clinical practice since 1982. The rate of total obliteration of AVMs was 97.5% at 3 years. 2 patients with posterior deficit after the radiosurgery procedure. 1 patient received endovascular therapy previous radiosurgery and in 2 cases performed partial resection by microsurgical technique before of treatment. The volume oscillated at less 10cm3 on 41 cases. The most frequent localization of the AVMs where parietal 13, temporal 11, frontal 10, brain steam 9, diencephalon 7 and cerebellum 1. 14 patients presented brain hemorrhage before de therapeutic procedure. Results: 28 women y 23 men treated, aged between 6 to 64 years. All treated by radiosurgery clinic from General Hospital of Mexico with linear accelerator (LINAC). Material and methods: We treated 173 patients between November 1999 to December 2006, 53 patients with least 3 year of following. Objective: To show the experience of the functional neurosurgery, stereotactic and radiosurgery unit on the treatment of arteriovenous malformation (AVMs) an determinate the grade of obliteration and the mobility associate to this procedure.
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