THE EFFICACY OF PARTICULATE EMBOLIZATION COMBINED WITH STEREOTAXIC RADIOSURGERY FOR TREATMENT OF LARGE ARTERIOVENOUS-MALFORMATIONS OF THE BRAIN

PURPOSE: To evaluate the efficacy of combined particulate embolization and single-stage stereotactic radiosurgery in the treatment of large arteriovenous malformations (AVMs) of the brain. METHODS: Twenty-four patients with large brain AVMs (diameter > 3.0 cm; volume > 14 cm(3)), who had previously undergone particulate embolization and stereotacti c radiosurgery, were retrospectively evaluated 2 or more years after r adiosurgery. RESULTS: In 12 (50%) of these patients there was complete AVM obliteration, comparing favorably with a 58% obliteration rate in a group of AVMs having a 4- to 10-cm(3) volume, treated by radiosurge ry alone. Recanalization of embolized, but not radiated, AVM segments was identified in 3 (12%) patients. However, long-term occlusion was d emonstrated in the embolized portions of most AVMs subsequently treate d by radiosurgery. Complications included 1 (4%) patient with a mild u pper extremity paresis after radiosurgery and 2 (8%) patients with tra nsient neurologic deficits after embolization. CONCLUSION: Combined em bolization and stereotactic radiosurgery was more efficacious than rad iosurgery alone for large brain AVMs. Recanalization after embolizatio n did occur but was a relatively minor cause of treatment failure.