Stereotactic radiosurgery for deep intracranial arteriovenous malformations,part 1: Brainstem arteriovenous malformations |
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| Affiliation: | 1. Ophthalmology, NDMVP Samaj’s Medical College, Nasik, India;2. Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH 413736, India;3. Ophthalmology, Acharya Vinoba Bhave Rural Hospital, Sawangi, India;4. The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA;2. Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA;3. Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA;4. Department of Radiology, University of California, San Francisco, San Francisco, California, USA;5. Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA;6. Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California, USA;1. Princess Alexandra Hospital, Queensland, Australia;2. Sunshine Coast University Hospital, Queensland, Australia;3. Royal Brisbane and Women Hospital, Queensland, Australia;1. Grande Ospedale Metropolitano Niguarda, Milano, Italy;2. Ospedale di Cremona, Cremona, Italy;3. Ospedale Bellaria, Bologna, Italy;4. Ospedale Civile, Legnano, Italy;5. Ospedale Molinette, Torino, Italy;6. Ospedale SS. Annunziata, Sassari, Italy;7. Ospedale Papa Giovanni XXIII, Bergamo, Italy;8. Ospedale Baggiovara, Modena, Italy;9. Istituto Neurologico Besta, Milano, Italy;10. Istituto Clinico Humanitas, Rozzano, Italy;11. Neurocheeta Discussion Group;1. Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;2. Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;3. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong |
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| Abstract: | The management of brainstem arteriovenous malformations (AVM) are one of the greatest challenges encountered by neurosurgeons. Brainstem AVM have a higher risk of hemorrhage compared to AVM in other locations, and rupture of these lesions commonly results in devastating neurological morbidity and mortality. The potential morbidity associated with currently available treatment modalities further compounds the complexity of decision making for affected patients. Stereotactic radiosurgery (SRS) has an important role in the management of brainstem AVM. SRS offers acceptable obliteration rates with lower risks of hemorrhage occurring during the latency period. Complex nidal architecture requires a multi-disciplinary treatment approach. Nidi partly involving subpial/epipial regions of the dorsal midbrain or cerebellopontine angle should be considered for a combination of endovascular embolization, micro-surgical resection and SRS. Considering the fact that incompletely obliterated lesions (even when reduced in size) could still cause lethal hemorrhages, additional treatment, including repeat SRS and surgical resection should be considered when complete obliteration is not achieved by first SRS. Patients with brainstem AVM require continued clinical and radiological observation and follow-up after SRS, well after angiographic obliteration has been confirmed. |
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| Keywords: | Brainstem Intracranial arteriovenous malformations Gamma Knife radiosurgery Outcome prediction RBAS VRAS |
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