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The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations

OBJECTIVE: To evaluate the role of preradiosurgical embolization on obliteration rate, reduction of size, irradiation dose, and neurological outcome, in 90 patients presenting large arteriovenous malformations (AVMs). METHODS: Between October 1993 and October 2006, 90 radiosurgical procedures were p...

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Autores principales: Sousa, Evandro C., Teixeira, Manoel J., Piske, Ronnie L., Albuquerque, Lavoisier S., Côrrea, Sebastião, Benabou, Salomão, Welling, Leonardo C., de Sousa, Leonardo Moura, Figueiredo, Eberval Gadelha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923073/
https://www.ncbi.nlm.nih.gov/pubmed/27446926
http://dx.doi.org/10.3389/fsurg.2016.00037
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author Sousa, Evandro C.
Teixeira, Manoel J.
Piske, Ronnie L.
Albuquerque, Lavoisier S.
Côrrea, Sebastião
Benabou, Salomão
Welling, Leonardo C.
de Sousa, Leonardo Moura
Figueiredo, Eberval Gadelha
author_facet Sousa, Evandro C.
Teixeira, Manoel J.
Piske, Ronnie L.
Albuquerque, Lavoisier S.
Côrrea, Sebastião
Benabou, Salomão
Welling, Leonardo C.
de Sousa, Leonardo Moura
Figueiredo, Eberval Gadelha
author_sort Sousa, Evandro C.
collection PubMed
description OBJECTIVE: To evaluate the role of preradiosurgical embolization on obliteration rate, reduction of size, irradiation dose, and neurological outcome, in 90 patients presenting large arteriovenous malformations (AVMs). METHODS: Between October 1993 and October 2006, 90 radiosurgical procedures were performed to treat brain AVMs Spetzler–Martin (SM) grades III, IV, and V at the Department of Radiosurgery and Radiology of the Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, Brazil. Fifty-nine patients had embolization before radiosurgery and complete clinical and radiologic follow-up for at least 3 years. Inclusion criteria were as follow: SM grades III, IV, and V AVMs, no previous treatment, and clinical and radiological (angiogram and MRI) follow-up for at least 3 years. Obliteration rate, reduction of size, irradiation dose, and neurological outcome were compared in these two cohorts of patients. Mann–Whitney test, “Student’s t-test,” and χ(2) tests were used for statistical analysis, as appropriate. The level of significance was determined at p < 0.05. RESULTS: The mean size of the AVMs that underwent embolization was significantly greater when compared with non-embolized group (p < 0.05). Embolization significantly reduced the AVM diameter. Irradiation dose was significantly smaller in the embolized group (p < 0.05). No significant differences in final clinical outcomes, postprocedural radiological findings, rate of occlusion, and need for additional procedures were observed between the two groups (p < 0.05). CONCLUSION: Preradiosurgical embolization of large AVMs does not result in impaired obliteration rate compared with cases treated with radiosurgery alone. It did not add further morbidity and presented benefits of reducing size of the AVMs. Preradiosurgical embolization may facilitate the coverage of the AVM with the effective irradiation dose. Combined management may be effective for selected large lesions considered unsuitable for radiosurgery and otherwise untreatable.
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spelling pubmed-49230732016-07-21 The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations Sousa, Evandro C. Teixeira, Manoel J. Piske, Ronnie L. Albuquerque, Lavoisier S. Côrrea, Sebastião Benabou, Salomão Welling, Leonardo C. de Sousa, Leonardo Moura Figueiredo, Eberval Gadelha Front Surg Surgery OBJECTIVE: To evaluate the role of preradiosurgical embolization on obliteration rate, reduction of size, irradiation dose, and neurological outcome, in 90 patients presenting large arteriovenous malformations (AVMs). METHODS: Between October 1993 and October 2006, 90 radiosurgical procedures were performed to treat brain AVMs Spetzler–Martin (SM) grades III, IV, and V at the Department of Radiosurgery and Radiology of the Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, Brazil. Fifty-nine patients had embolization before radiosurgery and complete clinical and radiologic follow-up for at least 3 years. Inclusion criteria were as follow: SM grades III, IV, and V AVMs, no previous treatment, and clinical and radiological (angiogram and MRI) follow-up for at least 3 years. Obliteration rate, reduction of size, irradiation dose, and neurological outcome were compared in these two cohorts of patients. Mann–Whitney test, “Student’s t-test,” and χ(2) tests were used for statistical analysis, as appropriate. The level of significance was determined at p < 0.05. RESULTS: The mean size of the AVMs that underwent embolization was significantly greater when compared with non-embolized group (p < 0.05). Embolization significantly reduced the AVM diameter. Irradiation dose was significantly smaller in the embolized group (p < 0.05). No significant differences in final clinical outcomes, postprocedural radiological findings, rate of occlusion, and need for additional procedures were observed between the two groups (p < 0.05). CONCLUSION: Preradiosurgical embolization of large AVMs does not result in impaired obliteration rate compared with cases treated with radiosurgery alone. It did not add further morbidity and presented benefits of reducing size of the AVMs. Preradiosurgical embolization may facilitate the coverage of the AVM with the effective irradiation dose. Combined management may be effective for selected large lesions considered unsuitable for radiosurgery and otherwise untreatable. Frontiers Media S.A. 2016-06-28 /pmc/articles/PMC4923073/ /pubmed/27446926 http://dx.doi.org/10.3389/fsurg.2016.00037 Text en Copyright © 2016 Sousa, Teixeira, Piske, Albuquerque, Côrrea, Benabou, Welling, de Sousa and Figueiredo. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Sousa, Evandro C.
Teixeira, Manoel J.
Piske, Ronnie L.
Albuquerque, Lavoisier S.
Côrrea, Sebastião
Benabou, Salomão
Welling, Leonardo C.
de Sousa, Leonardo Moura
Figueiredo, Eberval Gadelha
The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations
title The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations
title_full The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations
title_fullStr The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations
title_full_unstemmed The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations
title_short The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations
title_sort role of preradiosurgical embolization in the management of grades iii, iv, and v arteriovenous malformations
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923073/
https://www.ncbi.nlm.nih.gov/pubmed/27446926
http://dx.doi.org/10.3389/fsurg.2016.00037
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