COMBINED EMBOLIZATION AND GAMMA-KNIFE RADIOSURGERY FOR CEREBRAL ARTERIOVENOUS-MALFORMATIONS

In a study of 46 patients with cerebral arteriovenous malformations (A VMs) the value of combining embolization and gamma knife radiosurgery was assessed. In 35 patients with large grade III to V AVMs (Spetzler- Martin system) staged combined treatment was planned. In 11 patients, radiosurgery complemented embolization for a residual AVM. The number of embolization sessions ranged from 1 to 7 (median 2). Twenty-six pat ients needed multiple embolization sessions. In 28 patients the grade of AVMs decreased as a result of embolization. In 16 patients collater al feeding vessels developed after embolization which made delineation of the residual nidus difficult. The time lag between the last emboli zation and radiosurgery ranged from 1 to 24 months (median 4). Ninetee n of 35 large grade III to V AVMs were possible to treat by radiosurge ry following embolization. In the 46 patients complications occurred i n 9 from embolization and in 2 from radiosurgery. Two patients had tra nsient and 9 had permanent neurologic deficits. It is concluded that e mbolization facilitates radiosurgery for some large AVMs and therefore this combined treatment has a role in the management of AVMs.