Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaVA-192New nidus found adjacent to the target site of AVM treatedwith Gamma Knife radiosurgery – Report of 3 cases1Do Hoon Kwon, 2 Byung Duk Kwun, 3 Jae Seung Ahn, 4 Do Hee Lee, 5 Hyun Jung Kim1Asan Medical Center, College of Medicine, Univ. of Ulsan, Seoul, Korea2Asan Medical Center3Asan Medical Center4Asan Medical Center5Asan Medical CenterObjective: The new nidus was rarely found adjacent to the resecting margin of nidus after surgicalresection of the AVM especially in the young age group. But the new nidus adjacent to the target siteof AVM treated with radiosurgery had not been reported yet. We reported and reviewed our caseexperiences retrospectively.Methods: The authors retrospectively analyzed their experience in 1,000 cases of AVMs treated withGamma Knife surgery during 20 years. Among them, 3 cases of new nidus were found adjacent tothe target site with an incidence rate of 0.3%. No patient had been treated with embolization beforeradiosurgery. All patent had a history of ICH before or after reradiosurgery.Results: First patient was a 9 year old boy who treated with Gamma Knife for left occipital AVM onemonth after ICH. Treated volume was 600 cumm and 25Gy was irradiated to the margin of the nidus.Thirty one months after radiosurgery, the patient had have 2nd radiosurgery for the new nidus whichwas found adjacent to the target site, treated volume was 900 cumm. Second patient was a 9 yearold boy treated with Gamma Knife for the small AVM located in the cerebellar vermis 1 month afterbleeding. Five years after radiosurgery, he had rebleeding and retreated to the same nidus with GammaKnife 2 month after rebleeding. Six years after 2nd treatment, he had a new nidus adjacent to thetarget site and the volume was increased from 400 cumm (2nd treated volume) to 2,800 cumm. Hehad have 3rd radiosurgery for this new nidus. Third patient was a 33 year old man who treated withradiosurgery for the incidentally detected cerebellar AVM, the nidus volume was 1,100 cumm and 20Gy was irradiated to the nidus. Three years after radiosurgery, patient had cerebellar ICH and newnidus was found adjacent to the target site and 2nd radiosurgery was performed, the nidus volumewas 500 cumm.Conclusions: The new nidus might be developed adjacent to the target site in the treatment of AVMwith radiosurgery, but the incidence was very rare.Key words: nidus, AVM, radiosurgery80
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaVA-266Gamma knife radiosurgery for dural arteriovenous fistulas:A meta-analysis of treatment strategy and results in fourdifferent Gamma knife centers1Huai Che Yang, 1 David Hung Chi Pan, 2 Wan Yuo Guo1Department of Neurosurgery, Taipei Veterans General Hospital2Department of Neuroradiology, Taipei Veterans General HospitalObjective: Treatment options for dural arteriovenous fistulas (DAVFs) have expanded with theapplication of Gamma knife radiosurgery (GKS). To assess the role of GKS in treatment of DAVFs,we reviewed our entire DAVF experience and compared with three recent published DAVFs GKStreatment series from different centers.Methods: Between 1993 and 2010, 368 DAVFs underwent GKS in our hospital. In our series, 216patients were Cavernous-carotid fistulas, 97 patients were transverse-sigmoid fistulas and 55 patientshad DAVF in other location. 327 patients (89%) had only Gamma knife treatment and other 41patients (11%) had combined treatment with embolization or surgery. Seventy-five patients (20%)were diagnosed after sustaining an intracranial hemorrhage. We found more than 95% of patientshad neurological symptom improvement during follow-up. Seventy percent of 216 patients withcavernous-carotid fistulas and 59% of patients with non cavernous-carotid fistulas had obliterationconfirmed by imaging.We selected three recent published GKS series from University of Pittsburgh, University of Virginia,and Karolinska University hospital (series at least had 40 patients with more than 3 years follow-uppublished in recent 5 years) for comparison. We compared patients’ selection, treatment strategy, doseplan, treatment results and complication of four different series and try to find out the commonconclusion in current GKS treatment for DAVFs.Conclusions: GKS is a safe and effective treatment modality for intracranial DAVFs. For lowrisk DAVFs with benign clinical presentation, GKS can serve as a primary treatment. Symptomimprovement rate and image proved obliteration rate can be achieved in more than 70% to 90%within 2 years with little adverse events. For high risk DAVFs with extensive retrograde corticalvenous drainage, hemorrhage or severe venous hypertension, treatment combined with embolizationor surgery is suggested.81
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Plenary Oral Presentations - Macquarie University Hospital

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