American Journal of Neuroradiology, Vol 14, Issue 2 297-303, Copyright © 1993 by American Society of Neuroradiology
ARTICLES |
Endovascular treatment of cerebral arteriovenous malformations following radiosurgery
MP Marks, B Lane, GK Steinberg, JI Fabrikant, RP Levy, KA Frankel and MH Phillips
Department of Diagnostic Radiology, Stanford University School of Medicine, CA.
PURPOSE: Previous reports of embolization of cerebral arteriovenous malformations (AVMs) have evaluated the technique as adjunctive therapy prior to surgery or radiosurgery; our aim is to assess the role of embolization following radiosurgery. PATIENTS: Six patients previously treated with radiosurgery and showing no response as judged by cerebral angiography were embolized 24 to 55 months (mean 34.3 months) after initial radiosurgery. RESULTS: In five of six, a significant volume reduction was achieved ranging from 60%-100% (mean 74%). One patient was treated with embolization alone and the AVM has remained fully thrombosed 2 years after treatment. Three patients underwent surgical resection for cure after embolization, and two patients had repeat radiosurgery to a significantly smaller AVM volume. One patient had an asymptomatic carotid dissection at embolization; however, no clinically apparent complications occurred in the treatment group. CONCLUSION: Embolization can be used after radiosurgery to assist in the management of those AVMs that have not responded to initial treatment.