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Pathological changes in surgically resected angiographically occult vascular malformations after radiation.

Gewirtz, RJ and Steinberg, GK and Crowley, Rebecca S and Levy, RP (1998) Pathological changes in surgically resected angiographically occult vascular malformations after radiation. Neurosurgery, 42 (4). 738 - 42; discussion 742. ISSN 0148-396X

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OBJECTIVE: The goal of this study was to evaluate the pathological changes associated with radiation treatment (stereotactic radiosurgery or conventional irradiation) of angiographically occult vascular malformations (AOVMs). METHODS: Eleven patients underwent surgical resection of an AOVM in the mesial temporal lobe, brain stem, thalamus, or basal ganglia after previous radiation treatment. The indications for surgery were recurrent symptomatic bleeding from the lesion in 10 patients and recurrent intractable seizures in 1 patient. Radiation was used as the initial therapy because the risk of surgical resection was deemed too high. Three patients received conventional radiation therapy of 3000 to 5400 rads at an outside institution. One patient received radiosurgery with the gamma knife at another institution using a dose of 15 Gy to the margin. The remaining 7 patients received stereotactic radiosurgery with a helium-ion particle beam. The dose range was from 18 to 26 Gy equivalents. The interval from radiation to surgical resection ranged from 1 to 10 years, with a mean of 3.5 years. These lesions were compared with 10 nonirradiated cavernous malformations. RESULTS: One irradiated lesion was identified pathologically as a true arteriovenous malformation despite being angiographically occult. This lesion did not demonstrate significant changes in the vasculature but did have radiation necrosis of the surrounding brain 5 years after 25 Gy equivalents of helium-ion radiosurgery. Two other specimens were too small to identify the type of vascular malformation adequately. Of the remaining eight malformations identified as cavernous malformations, six showed a combination of marked fibrosis of the vascular channels, fibrinoid necrosis, and ferrugination. However, the fibrinoid necrosis was the only finding unique to the irradiated lesions compared with nonirradiated controls. All the irradiated lesions still had patent vascular channels; none were completely thrombosed. CONCLUSION: Radiosurgery or conventional radiation therapy did not cause histologic vascular obliteration in intracranial AOVMs evaluated 1 to 10 years (mean 3.5 yr) after radiation delivery. It should be recognized that these patients are irradiation failures who may not be representative of all irradiated patients. However, recurrent bleeding from AOVMs may relate to poor radiation response in some patients.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Gewirtz, RJ
Steinberg, GK
Crowley, Rebecca S
Levy, RP
Date: April 1998
Date Type: Publication
Journal or Publication Title: Neurosurgery
Volume: 42
Number: 4
Page Range: 738 - 42; discussion 742
Schools and Programs: School of Medicine > Biomedical Informatics
Refereed: Yes
ISSN: 0148-396X
Article Type: Research Article
MeSH Headings: Cerebral Angiography; Humans; Intracranial Arteriovenous Malformations--pathology; Intracranial Arteriovenous Malformations--radiotherapy; Intracranial Arteriovenous Malformations--surgery; Radiosurgery; Retreatment; Stereotaxic Techniques; Time Factors; Treatment Outcome
PubMed ID: 9574637
Date Deposited: 04 Oct 2012 21:36
Last Modified: 01 Nov 2017 14:03


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