Gamma knife surgery for previously irradiated arteriovenous malformations.

OBJECTIVE

The goal was to report the treatment results after a second gamma knife treatment and to compare them with the results obtained after a first gamma knife treatment, as well as to investigate whether the models to predict the results after a first treatment are also applicable after gamma knife treatment of previously irradiated arteriovenous malformations.

METHODS

The number of complications and the posttreatment hemorrhage rate were recorded for 112 patients in the study, and the number of obliterations was recorded for the 101 patients for whom conclusive angiograms were obtained. The results were compared with the expected results after a first gamma knife treatment.

RESULTS

The observed number of obliterations was 62, which is not significantly different from the predicted number of 65. There were 14 observed and 5 predicted complications. When the risk from the preceding radiation treatment was added, the observed number of complications was similar to the predicted number. Six hemorrhages were observed after the second treatment. Of the 5 patients with unchanged arteriovenous malformation size after both the first and second treatments, 2 experienced hemorrhages after the second treatment, compared with none among the 81 patients for whom the malformation was obliterated or significantly decreased in size after the second treatment.

CONCLUSIONS

The obliteration rate after gamma knife surgery for previously irradiated arteriovenous malformations is similar to that after primary gamma knife treatment. The complication rate increases with the amount of radiation previously given. The incidence of posttreatment hemorrhages is lower in the latency period if the malformation is affected by the radiation.