부산대학교 도서관

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ijrobp.2005.09.024 Byline: Angelika Zabel-du Bois ([cor])(a ), Stefanie Milker-Zabel (a ), Peter Huber ([cor]), Wolfgang Schlegel (a ), Jurgen Debus (a ) Keywords: Stereotactic radiosurgery; Deep AVM; Obliteration rate; Brainstem; Intracranial hemorrhage Abstract: Purpose: To evaluate patient outcome and obliteration rates after radiosurgery (RS) for cerebral arteriovenous malformations (AVM) located deep, in the motor cortex or brainstem and those involving corpus callosum. Methods and Materials: This analysis is based on 65 patients. AVM classification according to Spetzler-Martin was 13 patients Grade 2, 39 Grade 3, 12 Grade 4, and 1 Grade 5. Median RS-based AVM score was 1.69. Median single dose was 18 Gy. Mean treatment volume was 5.2 cc (range, 0.2-26.5 cc). Forty patients (62%) experienced intracranial hemorrhage before RS. Median follow-up was 3.0 years. Results: Actuarial complete obliteration rate (CO) was 50% and 65% after 3 and 5 years, respectively. CO was significantly higher in AVM 18 Gy (p < 0.009). Annual bleeding risk after RS was 4.7%, 3.4%, and 2.7% after 1, 2, and 3 years, respectively. AVM >3 cm (p < 0.01), AVM volume >4 cc (p < 0.009), and AVM score >1.5 (p < 0.02) showed a significant higher bleeding risk. Neurologic dysfunction improved, completely dissolved, or remained stable in 94% of patients. Conclusions: Surgically inaccessible AVM can be successfully treated using RS with acceptable obliteration rates and low risk for late morbidity. The risk of intracranial hemorrhage is reduced after RS and depends on RS-based AVM score. Author Affiliation: ([cor]) Department of Radiotherapy, German Cancer Research Center, Heidelberg, Germany (a ) Department of Medical Physics, German Cancer Research Center, Heidelberg, Germany (a ) Department of RadioOncology, University of Heidelberg, Heidelberg, Germany Article History: Received 6 July 2005; Revised 21 September 2005; Accepted 27 September 2005