title: Embolization with Gamma Knife Radiosurgery of Giant Intracranial Arteriovenous Malformations.
abstract: OBJECTIVE
  Giant arteriovenous malformations (i.e., those greater than 6 cm maximum diameter or volume > 33 cc) are difficult to treat and often carry higher treatment morbidity and mortality rates. In our study, we reviewed the angiographic results and clinical outcomes for 11 patients with giant arteriovenous malformations who were treated between 1994 and 2012.
  
  
  METHODS
  The patients selected included 9 males (82%) and 2 females (18%). Their presenting symptoms were hemorrhage (n=2; 18%), seizure (n=7; 64%), and headache (n=2; 12%). Nine patients were Spetzler-Martin Grade III, 2 were Spetzler-Martin Grade IV. The mean arteriovenous malformation volume was 41 cc (33-52 cc). The mean age of the patients was 45.1 years (24-57 years) and the mean radiation dose delivered to the margin of the nidus was 14.2 Gy.
  
  
  RESULTS
  Ten patients received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery, 1 patient received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery twice and the interval between Gamma Knife radiosurgeries was 3 months. The complete obliteration rate following Gamma Knife radiosurgery was 36%, subtotal obliteration ( > 70% decreased size of nidus) was 36%, and partial obliteration was 28%. One patient experienced a small hemorrhage after embolization.
  
  
  CONCLUSIONS
  Combined embolization and Gamma Knife radiosurgery showed successful obliteration of the arteriovenous malformation nidus. The use of embolization to initially reduce nidus size followed by Gamma Knife radiosurgery improves the treatment results. Repeated Gamma Knife radiosurgery should be a treatment option when there is a small nidus remnant.
authors.affiliation: Inje University, School of Medicine, Busan Paik Hospital, Department of Neurosurgery, Busan, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Chun
authors.forename: Moo Seong
authors.initials: MS
authors.lastname: Kim
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Sung Hwa
authors.initials: SH
authors.lastname: Paeng
authors.forename: Hae Woong
authors.initials: HW
authors.lastname: Jeong
authors.forename: Won Hee
authors.initials: WH
authors.lastname: Lee
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome