title: Analysis of X-knife and surgery in treatment of arteriovenous malformation of brain.
abstract: BACKGROUND
  The goal of treatment in arteriovenous malformation (AVM) is total obliteration of the AVM, restoration of normal cerebral function, and preservation of life and neurological function.
  
  
  OBJECTIVE
  To analyze the results of X-knife and surgery for AVM of the brain. The endpoints for success or failure were as follows: success was defined as angiographic obliteration and failure as residual lesion, requiring retreatment, or death due to hemorrhage from the AVM.
  
  
  METHODS
  From May 2002 to May 2007, 54 patients were enrolled for this study. Grade I AVM was seen in 9%, grade II in 43%, grade III in 26%, grade IV in 9%, and grade V in 13%. Thirty-eight patients were treated by microsurgical resection out of which Grade I was seen in 5 patients, Grade II was seen in 17 patients, Grade III was seen in 9 patients and Grade V was seen in 7 patients. Rest of the sixteen patients were treated by linear accelerator radiosurgery out of which Grade II was seen in 6 patients, Grade III was seen in 5 patients and Grade IV was seen in 5 patients. The follow up was in range of 3-63 months. In follow up, digital subtraction angiography/ magnetic resonance angiography (DSA/MRA) was performed 3 months after surgery and 1 year and 2 years after stereotactic radiosurgery (SRS).
  
  
  RESULTS
  Among the patients treated with X-knife, 12/16 (75%) had proven angiographic obliteration. Complications were seen in 4/16 (25%) patients. Among the patients treated with microsurgical resection, 23/38 (61%) had proven angiographic obliteration. Complications (both intraoperative and postoperative) were seen in 19/38 (50%) patients.
  
  
  CONCLUSIONS
  Sixty-one percent of patients were candidates for surgical resection. X-knife is a good modality of treatment for a low-grade AVM situated in eloquent areas of the brain and also for high-grade AVMs, when the surgical risk and morbidity is high.
authors.affiliation: Department of Radiation Oncology, Gujarat Cancer and Research Institute, Ahmedabad, India. drpoojanandwanipatel@yahoo.co.in
authors.forename: Pooja Nandwani
authors.initials: PN
authors.lastname: Patel
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Vyas
authors.forename: Devang C
authors.initials: DC
authors.lastname: Bhavsar
authors.forename: U K
authors.initials: UK
authors.lastname: Suryanarayan
authors.forename: Satish
authors.initials: S
authors.lastname: Pelagade
authors.forename: Dipak
authors.initials: D
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001921:Brain / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome