The effective surgical management of competitive venous outflow restriction after radiosurgery for cerebral AVMs: Report of 2 cases.

The effective surgical management of competitive venous outflow restriction after radiosurgery for cerebral AVMs: Report of 2 cases.

World Neurosurg. 2016 Nov 9;:

Authors: Fennell VS, Martirosyan NL, Atwal GS, Kalani MY, Spetzler RF, Lemole GM, Dumont T

Abstract
BACKGROUND: Intracranial arteriovenous malformations (AVMs) are complex pathologies. For patients who do not present with hemorrhage, treatment strategies are often predicated on reducing the risk of hemorrhage and minimizing morbidity. Outcomes vary according to the efficacy of treatment selected. Radiosurgical treatment of certain AVMs can result in incomplete obliteration and may also have only a minimal effect on the presenting non-hemorrhagic symptoms.
CASE DESCRIPTIONS: We present 2 cases of patients with AVMs who were initially treated with radiosurgery. Both patients' primary clinical symptoms were headaches, which persisted after radiosurgical treatment but abated after subsequent microsurgical resection with or without endovascular embolization.
CONCLUSION: Venous outflow obstruction is likely a sizable contributive factor in occipital AVMs among patients who present with headaches and symptoms of intracranial hypertension. Because these high-flow lesions may be suboptimally responsive to stereotactic radiosurgery, microsurgical resection, with or without adjunctive endovascular embolization, should be considered as an initial and definitive treatment strategy. Optimal outcomes may be achieved in patients with a visual deficit an anatomically correlated to their AVMs.

PMID: 27838427 [PubMed - as supplied by publisher]

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