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Minim Invasive Neurosurg 2002; 45(4): 211-223
DOI: 10.1055/s-2002-36200
Original Article
© Georg Thieme Verlag Stuttgart · New York

Gamma Knife Radiosurgery in the Management of Arteriovenous Malformations of the Basal Ganglia Region of the Brain

A.  Nicolato1 , R.  Foroni1 , A.  Crocco1 , P.  G.  Zampieri1 , F.  Alessandrini1 , A.  Bricolo1 , M.  A.  Gerosa1
  • 1Department of Neurosurgery, University Hospital, Verona, Italy
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Publication History

Publication Date:
20 December 2002 (online)

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Abstract

Objectives: The authors report the results of gamma knife (GK) radiosurgery on a clinical series of selected patients with basal ganglia arteriovenous malformations (BGAVMs) in the brain. Clinical, epidemiological, anatomical and functional characteristics of BGAVMs and of supratentorial cortical AVMs are comparatively analyzed, and their influence on radiosurgical outcome is discussed.

Methods: At our Department, 33 BGAVMs (21 with FU > 2 years) and 209 cortical AVMs (110 with FU > 2 years) with a radiosurgical volume ≤ 10 cc were treated with GK between February 1993 and July 2001. Mean age, male/female ratio (M/F), and incidence of haemorrhagic onset in the two subgroups of patients were as follows: 25.5 years (5 - 62 years), 16 M/17 F, and 30/33 (91 %) in BGAVMs; 34.4 years (8 - 74 years), 124 M/85 F, and 107/209 (51 %) in cortical AVMs. Statistical analysis performed using the contingency table method and deviance analysis according to generalized linear models showed that the differences in age and incidence of haemorrhagic onset were highly significant.

Results: The rates of complete obliteration, permanent morbidity, bleeding/rebleeding during the latency period, and unsuccessful embolisation attempts in the two subgroups of patients were as follows: 81 %, 4 %, 8 %, and 41.7 %, respectively, in BGAVMs; 85.5 %, 2 %, 2 %, and 2 % in cortical AVMs. Statistical analysis did not show any significant difference between the two subgroups of patients in the rates of complete obliteration, permanent morbidity, or latency period bleeding/rebleeding, while difference in failed embolization rates resulted to be highly significant (P = 0.00003).

Conclusions: In our experience, the different clinical, epidemiological and anatomico-functional characteristics of BGAVMs and cortical AVMs do not seem to influence the radiosurgical outcome, since complete obliteration and permanent neurological sequelae rates were very similar in these two subgroups of patients. GK may be considered the first choice treatment modality for BGAVMs with < 10 cc volume, since it offers a very high cure rate, very low permanent morbidity, and zero mortality. Although haemorrhagic onset is much more frequent in BGAVMs than in cortical AVMs, the difference between the bleeding/rebleeding rates in the two subgroups of patients during the latency period is not statistically significant, and seems to be limited to the first year after GK.

Key words

Arteriovenous Malformations of the Brain - Radiosurgery - Gamma Knife - Basal Ganglia - Thalamus

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A. Nicolato,M. D. 

Department of Neurosurgery · University Hospital

Piazzale Stefani 1

37126 Verona · Italy

Phone: +45-807-3023

Fax: +45-807-2939

Email: antonio.nicolato@mail.azosp.vr.it

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