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Journal of Korean Neurosurgical Society 2004;36(5): 363-368. |
| Post-treatment Bleeding of Cerebral Arteriovenous Malformations after Gamma Knife Radiosurgery. |
| Seok Keun Choi, Young Jin Lim, Jun Seok Koh, Bong Arm Rhee, Gook Ki Kim, Tae Sung Kim |
| Department of Neurosurgery, School of Medicine, Kyung-Hee University, Seoul, Korea. youngjinns@yahoo.co.kr |
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| ABSTRACT |
OBJECTIVE
This study is designed to assess the cause of post-treatment bleeding after gamma knife radiosurgery(GKRS) for cerebral arteriovenous malformation(AVM). METHODS: We experienced post-treatment bleeding in seven cases out of 214 AVM patients group before complete obliteration and analyzed their clinical characteristics, angiographic architecture and radiosurgical dosimetry. RESULTS: Hemorrhage rate was 3.2% (7/214) and the bleeding occurred individually at 4, 8, 9, 20, 44, 44 and 115 months after GKRS. Annual bleeding rate was 0.6% (7 episodes of bleeding / 1131 patient years). Three patients presented with hemorrhage as initial symptom upon admission and four patients were admitted with other symptom rather than hemorrhage. AVM was deep-seated in 4 cases, and at motor cortex in three patients. Average marginal dose was 18.9Gy (range;10-25Gy). Most of patients showed angiographic risk factor for bleeding such as venous aneurysm, multiple venous drainage, dual arterial supply and shunt type. Upon bleeding incidence, emergency operation was performed in 5 cases and two patients received second GKRS. Two patients were expired after emergency operation. CONCLUSION: The risk of hemorrhage from GKRS for AVMs is inevitable, even if patients are in non-hemorrhagic group before complete obliteration. In order to minimize hemorrhage rate, intensive follow-up is strongly suggested after radiosurgery, and the retreatment for a residual nidus is recommended at early point after the latency period. |
| Key Words:
Post-treatment bleeding; Gamma knife radiosurgery; Arteriovenous malformation |
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