The efficacy of particulate embolization combined with stereotactic radiosurgery for treatment of large arteriovenous malformations of the brain.
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.
Mathis
J A
JA
Division of Neuroradiology, University of Pittsburgh, USA.
Barr
J D
JD
Horton
J A
JA
Jungreis
C A
CA
Lunsford
L D
LD
Kondziolka
D S
DS
Vincent
D
D
Pentheny
S
S
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