Radiosurgery for Cerebral Arteriovenous Malformation (AVM) : Current Treatment Strategy and Radiosurgical Technique for Large Cerebral AVM
| Autor: | Byun, Joonho, Kwon, Do Hoon, Lee, Do Heui, Park, Wonhyoung, Park, Jung Cheol, Ahn, Jae Sung |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Review Article Radiosurgery Effective dose (radiation) 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Arteriovenous malformations Vascular medicine Embolization business.industry General Neuroscience Arteriovenous malformation medicine.disease Radiological weapon Surgery Neurology (clinical) Radiology Complication business 030217 neurology & neurosurgery Shunt (electrical) |
| Zdroj: | Journal of Korean Neurosurgical Society |
| ISSN: | 1598-7876 2005-3711 |
| Popis: | Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system. AVM harbors 2.2% annual hemorrhage risk in unruptured cases and 4.5% annual hemorrhage risk of previously ruptured cases. Stereotactic radiosurgery (SRS) have been shown excellent treatment outcomes for patients with small- to moderated sized AVM which can be achieved in 80-90% complete obliteration rate with a 2-3 years latency period. The most important factors are associated with obliteration after SRS is the radiation dose to the AVM. In our institutional clinical practice, now 22 Gy (50% isodose line) dose of radiation has been used for treatment of cerebral AVM in single-session radiosurgery. However, dose-volume relationship can be unfavorable for large AVMs when treated in a single-session radiosurgery, resulting high complication rates for effective dose. Thus, various strategies should be considered to treat large AVM. The role of pre-SRS embolization is permanent volume reduction of the nidus and treat high-risk lesion such as AVM-related aneurysm and high-flow arteriovenous shunt. Various staging technique of radiosurgery including volume-staged radiosurgery, hypofractionated radiotherapy and dose-staged radiosurgery are possible option for large AVM. The incidence of post-radiosurgery complication is varied, the incidence rate of radiological post-radiosurgical complication has been reported 30-40% and symptomatic complication rate was reported from 8.1% to 11.8%. In the future, novel therapy which incorporate endovascular treatment using liquid embolic material and new radiosurgical technique such as gene or cytokine-targeted radio-sensitization should be needed. |
| Databáze: | OpenAIRE |
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