title: The efficacy of particulate embolization combined with stereotactic radiosurgery for treatment of large arteriovenous malformations of the brain.
abstract: OBJECTIVE
  To evaluate the efficacy of combined particulate embolization and single-stage stereotactic radiosurgery in the treatment of large arteriovenous malformations (AVMs) of the brain.
  
  
  METHODS
  Twenty-four patients with large brain AVMs (diameter > 3.0 cm; volume > 14 cm3), who had previously undergone particulate embolization and stereotactic radiosurgery, were retrospectively evaluated 2 or more years after radiosurgery.
  
  
  RESULTS
  In 12 (50%) of these patients there was complete AVM obliteration, comparing favorably with a 58% obliteration rate in a group of AVMs having a 4- to 10-cm3 volume, treated by radiosurgery alone. Recanalization of embolized, but not radiated, AVM segments was identified in 3 (12%) patients. However, long-term occlusion was demonstrated in the embolized portions of most AVMs subsequently treated by radiosurgery. Complications included 1 (4%) patient with a mild upper extremity paresis after radiosurgery and 2 (8%) patients with transient neurologic deficits after embolization.
  
  
  CONCLUSIONS
  Combined embolization and stereotactic radiosurgery was more efficacious than radiosurgery alone for large brain AVMs. Recanalization after embolization did occur but was a relatively minor cause of treatment failure.
authors.affiliation: Division of Neuroradiology, University of Pittsburgh, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Mathis
authors.forename: J D
authors.initials: JD
authors.lastname: Barr
authors.forename: J A
authors.initials: JA
authors.lastname: Horton
authors.forename: C A
authors.initials: CA
authors.lastname: Jungreis
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
authors.forename: D S
authors.initials: DS
authors.lastname: Kondziolka
authors.forename: D
authors.initials: D
authors.lastname: Vincent
authors.forename: S
authors.initials: S
authors.lastname: Pentheny
mesh_terms: D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015641:Radiography, Interventional; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies