Multimodality treatment of giant intracranial arteriovenous malformations

Steven D. Chang, Mary L. Marcellus, Michael P. Marks, Richard P. Levy, Huy M. Do, Gary K. Steinberg, Robert H. Rosenwasser, L. Dade Lunsford, Patrick P. Han, Robert F. Spetzler, H. Hunt Batjer, Warren R. Selman

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

OBJECTIVE: Giant arteriovenous malformations (AVMs) (i.e., those greater than 6 cm at maximum diameter) are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVMs. In this study, we reviewed the treatment, angiographic results, and clinical outcomes in 53 patients with giant AVMs who were treated at Stanford between 1987 and 2001. METHODS: The patients selected included 20 males (38%) and 33 females (62%). Their presenting symptoms were hemorrhage (n = 20; 38%), seizures (n = 18; 34%), headaches (n = 8; 15%), and progressive neurological deficits (n = 7; 13%). One patient was in Spetzler-Martin Grade III, 9 were in Spetzler-Martin Grade IV, and 43 were in Spetzler-Martin Grade V. The mean AVM size was 6.8 cm (range, 6-15 cm). AVM venous drainage was superficial (n = 7), deep (n = 20), or both (n = 26). At presentation, 31 patients (58%) were graded in excellent neurological condition, 17 were graded good (32%), and 5 were graded poor (9%). RESULTS: The patients were treated with surgery (n = 27; 51%), embolization (n = 52; 98%), and/or radiosurgery (n = 47; 89%). Most patients received multimodality treatment with embolization followed by surgery (n = 5), embolization followed by radiosurgery (n = 23), or embolization, radiosurgery, and surgery (n = 23). Nineteen patients (36%) were completely cured of their giant AVMs, 90% obliteration was achieved in 4 patients (8%), less than 90% obliteration was achieved in 29 patients (55%) who had residual AVMs even after multimodality therapy, and 1 patient was lost to follow-up. Of the 33 patients who either completed treatment or were alive more than 3 years after undergoing their most recent radiosurgery, 19 patients (58%) were cured of their AVMs. The long-term treatment-related morbidity rate was 15%. The clinical results after mean follow-up of 37 months were 27 excellent (51%), 15 good (28%), 3 poor (6%), and 8 dead (15%). CONCLUSION: The results in this series of patients with giant AVMs, which represents the largest series reported to date, suggest that selected symptomatic patients with giant AVMs can be treated successfully with good outcomes and acceptable risk. Multimodality treatment is usually necessary to achieve AVM obliteration.

Original languageEnglish (US)
Pages (from-to)1-13
Number of pages13
JournalNeurosurgery
Volume53
Issue number1
StatePublished - Jul 1 2003

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Intracranial Arteriovenous Malformations
Arteriovenous Malformations
Radiosurgery
Therapeutics
Morbidity
Lost to Follow-Up

Keywords

  • Arteriovenous malformation
  • Embolization
  • Microsurgery
  • Multimodality therapy
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Chang, S. D., Marcellus, M. L., Marks, M. P., Levy, R. P., Do, H. M., Steinberg, G. K., ... Selman, W. R. (2003). Multimodality treatment of giant intracranial arteriovenous malformations. Neurosurgery, 53(1), 1-13.

Multimodality treatment of giant intracranial arteriovenous malformations. / Chang, Steven D.; Marcellus, Mary L.; Marks, Michael P.; Levy, Richard P.; Do, Huy M.; Steinberg, Gary K.; Rosenwasser, Robert H.; Lunsford, L. Dade; Han, Patrick P.; Spetzler, Robert F.; Batjer, H. Hunt; Selman, Warren R.

In: Neurosurgery, Vol. 53, No. 1, 01.07.2003, p. 1-13.

Research output: Contribution to journalArticle

Chang, SD, Marcellus, ML, Marks, MP, Levy, RP, Do, HM, Steinberg, GK, Rosenwasser, RH, Lunsford, LD, Han, PP, Spetzler, RF, Batjer, HH & Selman, WR 2003, 'Multimodality treatment of giant intracranial arteriovenous malformations', Neurosurgery, vol. 53, no. 1, pp. 1-13.
Chang SD, Marcellus ML, Marks MP, Levy RP, Do HM, Steinberg GK et al. Multimodality treatment of giant intracranial arteriovenous malformations. Neurosurgery. 2003 Jul 1;53(1):1-13.
Chang, Steven D. ; Marcellus, Mary L. ; Marks, Michael P. ; Levy, Richard P. ; Do, Huy M. ; Steinberg, Gary K. ; Rosenwasser, Robert H. ; Lunsford, L. Dade ; Han, Patrick P. ; Spetzler, Robert F. ; Batjer, H. Hunt ; Selman, Warren R. / Multimodality treatment of giant intracranial arteriovenous malformations. In: Neurosurgery. 2003 ; Vol. 53, No. 1. pp. 1-13.
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abstract = "OBJECTIVE: Giant arteriovenous malformations (AVMs) (i.e., those greater than 6 cm at maximum diameter) are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVMs. In this study, we reviewed the treatment, angiographic results, and clinical outcomes in 53 patients with giant AVMs who were treated at Stanford between 1987 and 2001. METHODS: The patients selected included 20 males (38{\%}) and 33 females (62{\%}). Their presenting symptoms were hemorrhage (n = 20; 38{\%}), seizures (n = 18; 34{\%}), headaches (n = 8; 15{\%}), and progressive neurological deficits (n = 7; 13{\%}). One patient was in Spetzler-Martin Grade III, 9 were in Spetzler-Martin Grade IV, and 43 were in Spetzler-Martin Grade V. The mean AVM size was 6.8 cm (range, 6-15 cm). AVM venous drainage was superficial (n = 7), deep (n = 20), or both (n = 26). At presentation, 31 patients (58{\%}) were graded in excellent neurological condition, 17 were graded good (32{\%}), and 5 were graded poor (9{\%}). RESULTS: The patients were treated with surgery (n = 27; 51{\%}), embolization (n = 52; 98{\%}), and/or radiosurgery (n = 47; 89{\%}). Most patients received multimodality treatment with embolization followed by surgery (n = 5), embolization followed by radiosurgery (n = 23), or embolization, radiosurgery, and surgery (n = 23). Nineteen patients (36{\%}) were completely cured of their giant AVMs, 90{\%} obliteration was achieved in 4 patients (8{\%}), less than 90{\%} obliteration was achieved in 29 patients (55{\%}) who had residual AVMs even after multimodality therapy, and 1 patient was lost to follow-up. Of the 33 patients who either completed treatment or were alive more than 3 years after undergoing their most recent radiosurgery, 19 patients (58{\%}) were cured of their AVMs. The long-term treatment-related morbidity rate was 15{\%}. The clinical results after mean follow-up of 37 months were 27 excellent (51{\%}), 15 good (28{\%}), 3 poor (6{\%}), and 8 dead (15{\%}). CONCLUSION: The results in this series of patients with giant AVMs, which represents the largest series reported to date, suggest that selected symptomatic patients with giant AVMs can be treated successfully with good outcomes and acceptable risk. Multimodality treatment is usually necessary to achieve AVM obliteration.",
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AU - Marcellus, Mary L.

AU - Marks, Michael P.

AU - Levy, Richard P.

AU - Do, Huy M.

AU - Steinberg, Gary K.

AU - Rosenwasser, Robert H.

AU - Lunsford, L. Dade

AU - Han, Patrick P.

AU - Spetzler, Robert F.

AU - Batjer, H. Hunt

AU - Selman, Warren R.

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N2 - OBJECTIVE: Giant arteriovenous malformations (AVMs) (i.e., those greater than 6 cm at maximum diameter) are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVMs. In this study, we reviewed the treatment, angiographic results, and clinical outcomes in 53 patients with giant AVMs who were treated at Stanford between 1987 and 2001. METHODS: The patients selected included 20 males (38%) and 33 females (62%). Their presenting symptoms were hemorrhage (n = 20; 38%), seizures (n = 18; 34%), headaches (n = 8; 15%), and progressive neurological deficits (n = 7; 13%). One patient was in Spetzler-Martin Grade III, 9 were in Spetzler-Martin Grade IV, and 43 were in Spetzler-Martin Grade V. The mean AVM size was 6.8 cm (range, 6-15 cm). AVM venous drainage was superficial (n = 7), deep (n = 20), or both (n = 26). At presentation, 31 patients (58%) were graded in excellent neurological condition, 17 were graded good (32%), and 5 were graded poor (9%). RESULTS: The patients were treated with surgery (n = 27; 51%), embolization (n = 52; 98%), and/or radiosurgery (n = 47; 89%). Most patients received multimodality treatment with embolization followed by surgery (n = 5), embolization followed by radiosurgery (n = 23), or embolization, radiosurgery, and surgery (n = 23). Nineteen patients (36%) were completely cured of their giant AVMs, 90% obliteration was achieved in 4 patients (8%), less than 90% obliteration was achieved in 29 patients (55%) who had residual AVMs even after multimodality therapy, and 1 patient was lost to follow-up. Of the 33 patients who either completed treatment or were alive more than 3 years after undergoing their most recent radiosurgery, 19 patients (58%) were cured of their AVMs. The long-term treatment-related morbidity rate was 15%. The clinical results after mean follow-up of 37 months were 27 excellent (51%), 15 good (28%), 3 poor (6%), and 8 dead (15%). CONCLUSION: The results in this series of patients with giant AVMs, which represents the largest series reported to date, suggest that selected symptomatic patients with giant AVMs can be treated successfully with good outcomes and acceptable risk. Multimodality treatment is usually necessary to achieve AVM obliteration.

AB - OBJECTIVE: Giant arteriovenous malformations (AVMs) (i.e., those greater than 6 cm at maximum diameter) are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVMs. In this study, we reviewed the treatment, angiographic results, and clinical outcomes in 53 patients with giant AVMs who were treated at Stanford between 1987 and 2001. METHODS: The patients selected included 20 males (38%) and 33 females (62%). Their presenting symptoms were hemorrhage (n = 20; 38%), seizures (n = 18; 34%), headaches (n = 8; 15%), and progressive neurological deficits (n = 7; 13%). One patient was in Spetzler-Martin Grade III, 9 were in Spetzler-Martin Grade IV, and 43 were in Spetzler-Martin Grade V. The mean AVM size was 6.8 cm (range, 6-15 cm). AVM venous drainage was superficial (n = 7), deep (n = 20), or both (n = 26). At presentation, 31 patients (58%) were graded in excellent neurological condition, 17 were graded good (32%), and 5 were graded poor (9%). RESULTS: The patients were treated with surgery (n = 27; 51%), embolization (n = 52; 98%), and/or radiosurgery (n = 47; 89%). Most patients received multimodality treatment with embolization followed by surgery (n = 5), embolization followed by radiosurgery (n = 23), or embolization, radiosurgery, and surgery (n = 23). Nineteen patients (36%) were completely cured of their giant AVMs, 90% obliteration was achieved in 4 patients (8%), less than 90% obliteration was achieved in 29 patients (55%) who had residual AVMs even after multimodality therapy, and 1 patient was lost to follow-up. Of the 33 patients who either completed treatment or were alive more than 3 years after undergoing their most recent radiosurgery, 19 patients (58%) were cured of their AVMs. The long-term treatment-related morbidity rate was 15%. The clinical results after mean follow-up of 37 months were 27 excellent (51%), 15 good (28%), 3 poor (6%), and 8 dead (15%). CONCLUSION: The results in this series of patients with giant AVMs, which represents the largest series reported to date, suggest that selected symptomatic patients with giant AVMs can be treated successfully with good outcomes and acceptable risk. Multimodality treatment is usually necessary to achieve AVM obliteration.

KW - Arteriovenous malformation

KW - Embolization

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