Ido Strauss1, Oz Haim2, Daniel Umansky2, Benjamin W Corn3, Vladimir Frolov4, Natan Shtraus5, Shimon Maimon4, Andrew A Kanner6. 1. The Stereotactic Radiosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: idos@tlvmc.gov.il. 2. Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 3. Institute of Radiation Therapy, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. The Invasive Neuroradiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 5. Institute of Radiation Therapy, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 6. The Stereotactic Radiosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Stereotactic radiosurgery (SRS) is a well-established treatment modality for cerebral arteriovenous malformations (AVMs). The main limiting factor in the radiosurgical treatment of AVMs is the volume of the nidus, with high-grade lesions often requiring combined treatment to reduce the SRS target volume. To overcome this limitation, we have been using a combined treatment approach consisting of endovascular embolization with Onyx followed by SRS. OBJECTIVE: To evaluate our clinical experience for safety and feasibility of this multimodality treatment approach. METHODS: This is a retrospective review of all adult patients with cerebral AVMs who received SRS treatment to their AVM after endovascular embolization with Onyx between June 2007 and June 2014. RESULTS: Thirty-five consecutive patients were identified. The mean follow-up period was 52.4 ± 22.6 months (range 18-97 months). We confirmed 18 (51.4%) complete nidus closures at a median time of 49.5 months (range 6.5-81 months) from SRS. High-resolution Magnetic resonance imaging/magnetic resonance angiography was performed routinely in all patients until closure of the nidus. Digital subtraction angiography was performed to confirm complete obliteration in 5 of the patients (28%); 13 patients are either planned for digital subtraction angiography or have refused it. In 6 patients (17%) a significant flow reduction was noted after a mean of 32 ± 16 months. No significant improvement was observed in 9 patients (26%) during the follow-up period. Two patients were lost to follow-up. CONCLUSIONS: The multimodality treatment of cerebral AVMs using embolization with Onyx followed by SRS is feasible and safe. The use of Onyx significantly reduced the SRS treatment target volume.
BACKGROUND: Stereotactic radiosurgery (SRS) is a well-established treatment modality for cerebral arteriovenous malformations (AVMs). The main limiting factor in the radiosurgical treatment of AVMs is the volume of the nidus, with high-grade lesions often requiring combined treatment to reduce the SRS target volume. To overcome this limitation, we have been using a combined treatment approach consisting of endovascular embolization with Onyx followed by SRS. OBJECTIVE: To evaluate our clinical experience for safety and feasibility of this multimodality treatment approach. METHODS: This is a retrospective review of all adult patients with cerebral AVMs who received SRS treatment to their AVM after endovascular embolization with Onyx between June 2007 and June 2014. RESULTS: Thirty-five consecutive patients were identified. The mean follow-up period was 52.4 ± 22.6 months (range 18-97 months). We confirmed 18 (51.4%) complete nidus closures at a median time of 49.5 months (range 6.5-81 months) from SRS. High-resolution Magnetic resonance imaging/magnetic resonance angiography was performed routinely in all patients until closure of the nidus. Digital subtraction angiography was performed to confirm complete obliteration in 5 of the patients (28%); 13 patients are either planned for digital subtraction angiography or have refused it. In 6 patients (17%) a significant flow reduction was noted after a mean of 32 ± 16 months. No significant improvement was observed in 9 patients (26%) during the follow-up period. Two patients were lost to follow-up. CONCLUSIONS: The multimodality treatment of cerebral AVMs using embolization with Onyx followed by SRS is feasible and safe. The use of Onyx significantly reduced the SRS treatment target volume.
Authors: Daniel Umansky; Benjamin W Corn; Ido Strauss; Natan Shtraus; Shlomi Constantini; Vladimir Frolov; Shimon Maimon; Andrew A Kanner Journal: Childs Nerv Syst Date: 2018-06-07 Impact factor: 1.475
Authors: Aditya Khurana; Patrick T Hangge; Hassan Albadawi; M-Grace Knuttinen; Sadeer J Alzubaidi; Sailendra G Naidu; J Scott Kriegshauser; Rahmi Oklu; Brian W Chong Journal: J Clin Med Date: 2018-05-09 Impact factor: 4.241