Treatment Of Cerebral Arteriovenous Malformations In Iran Gamma Knife Center

Keywords: arteriovenous malformation, radiosurgery, gamma knife, outcome, vascular

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     Radiation treatment of arteriovenous malformations (AVMs) has a slow and progressive vaso-occlusive effect.
     This study reviews the long-term clinical results of stereotactic radiosurgery in the treatment of Arteriovenous Malformation (AVM) patients in Iran Gamma Knife Center.
     We reviewed the outcomes of 233 patients who underwent Gamma Knife radiosurgery for AVMs in 4 years starting from 2002.
     The results are compared to other contemporary radiosurgical series.
     95% of patients with AVMs had imaging follow-up. Complete obliteration in angiographic studies in 45% of the patients in the first year and 90% in 3 years was observed and also reduction in lesion volume was noted in MRI studies in 65% of cases after 3 years. Complications such as transient hemi-paresis, VA and VF defect, cranial nerves palsy and very low rate of re-bleeding mostly in first year & in subtotal obliteration was observed.
     This is a retrospective study.
     AVMs are well-suited for radiosurgery, since radiation can be focused on a well circumscribed region, while adjacent neural structures are spared.
     Cortically located AVMs with a nidus volume less than 10 ml could be operated, with or without pre-surgical embolisation, unless there is a single feeder that can easily be catheterised and embolised for obliteration,or other obvious target for embolisation such as pseudoaneurysms or large fistulae. Centrally located AVMs with a nidus volume less than 10 ml should be treated by radiosurgery, unless suitable for embolisation as indicated above.


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