Visual field preservation after curative multi-modality treatment of occipital lobe arteriovenous malformations.
OBJECTIVE
Occipital lobe arteriovenous malformations (AVMs) provide challenging management decisions because of their proximity to the visual cortex and optic radiations. Preservation of visual function throughout treatment is the mainstay of therapeutic planning. We reviewed visual field (VF) outcomes of all patients who received curative treatment for occipital AVMs at Stanford University to evaluate the efficacy of different treatment strategies.


METHODS
We conducted a retrospective review of 55 patients with occipital AVMs treated at Stanford University between 1984 and 2003. Clinical presentation, AVM morphology, and treatment modality were correlated with VF function before and after therapeutic intervention.


RESULTS
Of 55 patients, 48 (87.3%) underwent multimodality AVM treatment (7 patients < 3 yr from radiosurgery were excluded from final analysis). One patient died from intracerebral hemorrhage 11 months post-radiosurgery, and five patients deferred further treatment. Forty-two patients (87.5%) were cured, with no residual AVM on final angiography. Curative therapeutic modalities used included embolization alone (2 patients), microsurgery alone (6 patients), microsurgery with radiosurgery (1 patient), microsurgery with embolization (23 patients), radiosurgery with embolization (4 patients), and embolization with radiosurgery and microsurgery (6 patients). Mean follow-up was 5.8 years including treatment. VF follow-up was available in all 42 patients. Twenty-eight (66.7%) patients experienced no change in VFs, six (14.3%) patients with previously abnormal VFs improved, and eight (19.0%) patients showed worsening of VFs (although none developed a new homonymous VF deficit). Duration of treatment was related to VF outcome in patients who presented without a history of AVM-related hemorrhage.


CONCLUSIONS
Occipital AVMs can be safely cured using multimodality strategies with minimal risk to visual function despite the proximity of these lesions to the visual cortex and associated pathways.
Sinclair
John
J
Department of Neurosurgery, The Stanford Stroke Center, Stanford University, Stanford, California 94305-5327, USA.
Marks
Michael P
MP
Levy
Richard P
RP
Adler
John R
JR
Chang
Steven D
SD
Lopez
Jaime R
JR
Do
Huy M
HM
Bell-Stephens
Teresa E
TE
Lim
Michael
M
Steinberg
Gary K
GK
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D014794:Visual Fields / Q000502:physiology*