Prospective evaluation of preoperative stereotactic radiosurgery followed by delayed resection of a high grade arteriovenous malformation.
Reports of the utility of preoperative radiation for shrinking large arteriovenous malformations (AVM) in preparation for resection have produced conflicting results, and to our knowledge no prospective studies are available. A 28-year-old man presented with a ruptured right temporal Spetzler-Martin Grade 5 AVM with deep venous drainage, involvement of the internal capsule, deep perforator supply, and a diffuse nidus. He underwent staged embolization, a single Gamma Knife (Elekta AB, Stockholm, Sweden) radiation treatment to the deepest portion of the nidus followed by complete surgical resection 3 years later. He suffered no long-term neurological deficits and has since returned to work symptom-free (modified Rankin Scale score 0). Preoperative radiosurgery is an effective method for downgrading high-grade AVM in preparation for surgery by targeting the deeper portions that abut or involve eloquent territory. To our knowledge this is the first such successful prospective report in the literature.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013, USA.
Hasan A
HA
Zaidi
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013, USA.
Adib A
AA
Abla
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013, USA.
Peter
P
Nakaji
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013, USA. Electronic address: Neuropub@dignityhealth.org.
Robert F
RF
Spetzler
D000328:Adult; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome
Arteriovenous malformation; Downgrading AVM; Radiation therapy; Spetzler-Martin grade