Staged Volume Radiosurgery Followed by Microsurgical Resection: A Novel Treatment for Giant Cerebral Arteriovenous Malformations: Technical Case Report

Staged Volume Radiosurgery Followed by Microsurgical Resection: A Novel Treatment for Giant... AbstractOBJECTIVE AND IMPORTANCEWe describe the successful treatment of symptomatic giant arteriovenous malformations (AVMs) using staged volume radiosurgery followed by microsurgical resection.CLINICAL PRESENTATIONA 57-year-old man presented with Spetzler-Martin Grade 5 AVMs, w ith persistent headaches and seizures. He had previously undergone eight attempts at AVM embolization and a craniotomy for attempted AVM resection; he had suffered four episodes of brain hemorrhaging but had made a good neurological recovery.INTERVENTIONBecause o f the persistent symptoms o f the patient and his history of hemorrhaging, a treatment plan based on staged radiosurgical treatments of d ifferent portions of the AVMs (three sessions, spaced 6 moapart), followed by delayed microsurgical removal of the much-reduced residual AVMs (3 years later), was undertaken. The patient did not suffer any additional hemorrhaging episodes, his AVMs were completely removed, and he has made a good recovery.CONCLUSIONStaged volume radiosurgery followed by microsurgical resection of the residual AVMs represents a novel treatment strategy for the management of Grade 5 AVMs that might be untreatable by any single treatment method used alone. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Staged Volume Radiosurgery Followed by Microsurgical Resection: A Novel Treatment for Giant Cerebral Arteriovenous Malformations: Technical Case Report

Staged Volume Radiosurgery Followed by Microsurgical Resection: A Novel Treatment for Giant Cerebral Arteriovenous Malformations: Technical Case Report

T E C H N I C A L C A S E R E P O R T S w h i c h w e r e d e t e r m i n e d to b e u n r e s e c t - Staged Volume Radiosurgery Followed by a b l e at th a t tim e . T h e p a t i e n t u n d e r w e n t s ix a t t e m p t s a t e m b o l i z a t i o n ( u s i n g G e l - Microsurgical Resection: A Novel f o a m [ T h e U p j o h n C o . , K a l a m a z o o , M I] a n d p o l y v i n y l a l c o h o l p a r t i c le s ) in th e 2 Treatment for Giant Cerebral y e a r s a f t e r d i a g n o s i s , w h i c h r e s u l t e d in p a rtia l n i d u s o b l i t e r a t i o n , b u t h e s u s ­ Arteriovenous Malformations: Technical t a in e d a n o t h e r h e m o r r h a g e , c a u s i n g r ig h t h e m i p a r e s i s a n d m o d e r a t e a p h a s i a . H e Case Report m a d e a n e x c e l l e n t r e c o v e r y f r o m this e v e n t , p r o m p t i n g t w o a d d i t i o n a l a t t e m p t s a t e m b o l i z a t i o n u s i n g p a r t i c le s , w h i c h r e ­ s u l t e d in f u r t h e r p a r tia l n i d u s r e d u c t i o n . Andrew D. Firlik, M .D., Elad I. Levy, M.D., T h r e e y e a r s a f t e r h is initial p r e s e n t a t i o n , Douglas Kondziolka, M .D., Howard Yonas, M.D. t h e p a t i e n t c o n t i n u e d to e x p e r i e n c e d e ­ Department of Neurological Surgery, University of Pittsburgh Medical Center, b i l i t a t i n g h e a d a c h e s , s e i z u r e s , a n d i n t e r ­ Pittsburgh, Pennsylvania m i t t e n t r i g h t - s i d e d p a r e s t h e s i a a n d h e m i p a r e s i s . In a n a t t e m p t to a m e l i o r a t e h i s s y m p t o m s a n d p r o t e c t h i m f r o m a n ­ o t h e r h e m o r r h a g e , a c r a n i o t o m y w a s OBJECTIVE A N D IM P O R T A N C E : W e d e scrib e th e successful tre a tm e n t o f p e r f o r m e d to s u r g i c a l l y l i g a t e a n d d i ­ symptomatic g ia n t a rte rio v e n o u s m a lfo rm a tio n s (A V M s) using staged r e c t l y e m...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199811000-00124
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE AND IMPORTANCEWe describe the successful treatment of symptomatic giant arteriovenous malformations (AVMs) using staged volume radiosurgery followed by microsurgical resection.CLINICAL PRESENTATIONA 57-year-old man presented with Spetzler-Martin Grade 5 AVMs, w ith persistent headaches and seizures. He had previously undergone eight attempts at AVM embolization and a craniotomy for attempted AVM resection; he had suffered four episodes of brain hemorrhaging but had made a good neurological recovery.INTERVENTIONBecause o f the persistent symptoms o f the patient and his history of hemorrhaging, a treatment plan based on staged radiosurgical treatments of d ifferent portions of the AVMs (three sessions, spaced 6 moapart), followed by delayed microsurgical removal of the much-reduced residual AVMs (3 years later), was undertaken. The patient did not suffer any additional hemorrhaging episodes, his AVMs were completely removed, and he has made a good recovery.CONCLUSIONStaged volume radiosurgery followed by microsurgical resection of the residual AVMs represents a novel treatment strategy for the management of Grade 5 AVMs that might be untreatable by any single treatment method used alone.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1998

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