Skip Navigation LinksHome > November 2013 - Volume 73 - Issue 5 > Radiosurgery for Primary Motor and Sensory Cortex Arterioven...
Neurosurgery:
doi: 10.1227/NEU.0000000000000106
Research-Human-Clinical Studies

Radiosurgery for Primary Motor and Sensory Cortex Arteriovenous Malformations: Outcomes and the Effect of Eloquent Location

Ding, Dale MD; Yen, Chun-Po MD; Xu, Zhiyuan MD; Starke, Robert M. MD, MSc; Sheehan, Jason P. MD, PhD

Collapse Box

Abstract

BACKGROUND: Eloquent intracranial arteriovenous malformations (AVMs) located in the primary motor or somatosensory cortex (PMSC) carry a high risk of microsurgical morbidity.

OBJECTIVE: To evaluate the outcomes of radiosurgery on PMSC AVMs and compare them with radiosurgery outcomes in a matched cohort of noneloquent lobar AVMs.

METHODS: Between 1989 and 2009, 134 patients with PMSC AVMs underwent Gamma Knife radiosurgery with a median radiographic and clinical follow-up of 64 and 80 months, respectively. Seizure (40.3%) and hemorrhage (28.4%) were the most common presenting symptoms. Pre-radiosurgery embolization was performed in 33.6% of AVMs. Median AVM volume was 4.1 mL (range, 0.1-22.6 mL), and prescription dose was 20 Gy (range, 7-30 Gy). Cox regression analysis was performed to identify factors associated with obliteration.

RESULTS: The overall obliteration rate, including magnetic resonance imaging and angiography, after radiosurgery was 63%. Obliteration was achieved in 80% of AVMs with a volume less than 3 mL compared with 55% for AVMs larger than 3 mL. No previous embolization (P = .002) and a single draining vein (P = .001) were independent predictors of obliteration on multivariate analysis. The annual post-radiosurgery hemorrhage risk was 2.5%. Radiosurgery-related morbidity was temporary and permanent in 14% and 6% of patients, respectively. Comparing PMSC AVMs with matched noneloquent lobar AVMs, the obliteration rates and clinical outcomes after radiosurgery were not statistically different.

CONCLUSION: For patients harboring PMSC AVMs, radiosurgery offers a reasonable chance of obliteration with a relatively low complication rate. Eloquent location does not appear to confer the same negative prognostic value for radiosurgery that it does for microsurgery.

ABBREVIATIONS: AVM, arteriovenous malformation

DSA, digital subtraction angiography

PMSC, primary motor or somatosensory cortex

RIC, radiation-induced change

Copyright © by the Congress of Neurological Surgeons

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.