The Efficacy Analysis Of Embolization Combined Gamma Knife Surgery In The Treatment Of Posterior Fossa Arteriovenous Malformations

Objective: To investigate the clinical effect of embolization combined with gamma knife surgery for AVM in the posterior fossa.Methods: We retrospectively analyzed 32 patients’ clinical and image data who were treated by embolization combined with gamma knife surgery in interventional neuroradiology department,Beijing Neurosurgery Institute between December 2011 and December 2015.Parameters like age,gender,presentation,lesion volume,AVM with or without aneurysm,feeder artery,draining vein,Spetzler-Martin grade,embolization procedure,margin dose,max dose were.Follow-up the obliteration rate,whether or not bleeding and neurological deficits are collected to analyse the imaging results and the clinical effect of combined treatment.Result: Sixty-two patients were identified with AVM in the posterior fossa,in which 15 were male(46.9%)and 17 female(53.1%).The mean age is 29.0 years,and 12 patients harbor associated aneurysms.The clinical presentation was hemorrhage in 23 patients,neurological deficits in 5,dizziness in 3 and headache in 2.The Spetzler-Martin grade was II in 8(25%),III in 17(53.1%),IV in 7(21.9%).32 patients were treated by interventional embolization forty-five times.Embolization related complications occurred in 6(18.8%)cases and only 2(6.3%)patient had permanent neurologic deficit.All AVM were partial embolized and were treated with the gamma knife within 1 week after embolization.Two had radioactive edema,one had cerebral hemorrhage,the symptoms were improved after conservative treatment.Follow-up was accomplished in 32 cases for a duration of 12-60 months.It showed that symptoms improved apparently in 21 cases,symptoms had no obvious change in 9 cases,2 cases had neurological deficit.32 cases were performed follow-up of DSA or MRA,15(46.9%)cases showed complete occlusion,17(53.1%)cases showed smaller.Factors associated with a higher rate of AVM obliteration included a smaller volume,a smaller maximum diameter,and longer time after GKS.Conclusions: Embolization combined with Gamma Knife surgery is an effective way to treat arteriovenous malformations in the posterior fossa.Targeted embolization eliminated the risk of bleeding,reduced the volume of AVM and improved the obliteration rate.