Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations.

Details

Serval ID
serval:BIB_8AF7CB2FAA21
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations.
Journal
Stereotactic and functional neurosurgery
Author(s)
Dedeciusova M., Tuleasca C., Hajdu S.D., Schiappacasse L., Patin D., Levivier M.
ISSN
1423-0372 (Electronic)
ISSN-L
1011-6125
Publication state
Published
Issued date
2020
Peer-reviewed
Oui
Volume
98
Number
6
Pages
424-431
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Head and neck extracranial arteriovenous malformations (AVMs) are rare pathological conditions which pose diagnostic and reconstruction challenges. Stereotactic radiosurgery (SRS) is nowadays an established treatment method for brain AVMs, with high obliteration and low complication rates. Here we describe the first report of head extracranial AVMs successfully treated by Gamma Knife (GK) as a retrospective historical cohort.
Over a 9-year period, 2 cases of extracranial AVMs were treated by GK Perfexion (Elekta Instruments AB, Stockholm, Sweden) at a single institution. A stereotactic frame and multimodal imaging, including digital subtraction angiography (DSA), were used. The prescribed dose was 24 Gy at the 50% isodose line.
The first case was of a patient with pulsating tinnitus and left superficial parotido-condylian AVM. Embolization achieved partial obliteration. Tinnitus disappeared during the following 6 months after GK. The second case was a patient with repetitive gingival hemorrhages and right superior maxillary AVM, fed by the right internal maxillary and facial arteries. Embolization achieved partial obliteration with recurrence of symptoms. GK was further performed. DSA confirmed complete obliteration in both patients.
Single-fraction GK radiosurgery appears to be safe and effective for extracranial AVMs. We recommend prescribing doses that are comparable to the ones used for brain AVMs (i.e., 24 Gy). A stereotactic frame is an important tool to ensure higher accuracy in the context of these particular locations. However, in selected cases, a mask could be applied either for single fraction purposes (if in a non-mobile location) or for hypofractionation, in case of larger volumes. These findings should be validated in larger cohorts, inclusively in terms of dose prescription.
Keywords
Arteriovenous malformations, Extracranial, Gamma Knife, Head, Radiosurgery
Pubmed
Web of science
Open Access
Yes
Funding(s)
University of Lausanne / Jeune Chercheur en Recherche Clinique
Create date
14/09/2020 8:19
Last modification date
30/12/2020 7:24
Usage data