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Year : 2021  |  Volume : 54  |  Issue : 2  |  Page : 45-51

Fractionated stereotactic radiosurgery in treating the complex intracranial arteriovenous malformations

Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; Department of Medicine, Chang Gung University, Taoyuan, Taiwan

Correspondence Address:
Peng-Wei Hsu
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 33305
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/fjs.fjs_88_20

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Background: The aim of this study was to examine the efficacy and safety of treating large or eloquently located intracranial arteriovenous malformations (AVMs) with fractionated stereotactic radiosurgery (FSRS). Materials and Methods: Eighteen patients with AVM treated with FSRS between March 2006 and August 2018 were retrospectively evaluated. The nidus obliteration, volume reduction, rate of rebleeding, newly onset neurological deficit, and signal change in magnetic resonance imaging (MRI) were evaluated. Results: With a median follow-up of 88 months (range: 24–154), 6 of the 18 lesions (33.3%) had a complete obliteration. All obliteration occurred in patients received the total treatment dose of 21 Gy (6 of 9 patients, 66.7%). The median time to complete obliteration was 38 months (range: 12–53). The mean volume reduction after FSRS in the 25 Gy group was 30.2% ± 20.9% and that in the 21 Gy group was 87.7% ± 24.2%. During the follow-up period, 4 of 18 (22.2%) lesions revealed T2 signal change in the MRI. No FSRS-related complication was noted clinically or radiologically. Conclusion: According to the present results, FSRS could be an effective and safe treatment alternative for complicated AVMs. Delayed toxicity after treatment is not noticed in the current study, but long-term follow-up is required. A higher dose in total and each fraction is likely needed when treating larger lesions.

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