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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
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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