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Bruce E Pollock

Publications and source records attributed to Bruce E Pollock.

At least 19 recordsLinked to original sources
PubMed2006

Central neurocytoma: management recommendations based on a 35-year experience.

PURPOSE: To examine the outcomes of patients with histologically confirmed central neurocytomas. METHODS AND MATERIALS: The data from 45 patients with central neurocytomas diagnosed between 1971 and 2003 were retrospectively evaluated. Various combinations of surgery, radiotherapy (RT), and chemotherapy had been used for treatment. RESULTS: The median follow-up was 10.0 years. The 10-year overall survival and local control rate was 83% and 60%, respectively. Patients whose tumor had a mitotic index of <3 (per 10 high-power fields) experienced a 10-year survival and local control rate of 89% and 74%, respectively, compared with 57% (p = 0.040) and 46% (p = 0.14) for patients with a tumor mitotic index of > or =3. The 10-year survival and local control rate was 90% and 74% for patients with typical tumors compared with 63% (p = 0.055) and 46% (p = 0.41) for those with atypical tumors. A comparison of gross total resection with subtotal resection showed no significant difference in survival or local control. Postoperative RT improved local control at 10 years (75% with RT vs. 51% without RT, p = 0.045); however, this did not translate into a survival benefit. No 1p19q deletions were found in the 19 tumors tested. CONCLUSION: Although the overall prognosis is quite favorable, one-third of patients experienced tumor recurrence or progression at 10 years, regardless of the extent of the initial resection. Postoperative RT significantly improved local control but not survival, most likely because of the effectiveness of salvage RT. For incompletely resected atypical tumors and/or those with a high mitotic index, consideration should be given to adjuvant RT because of the more aggressive nature.

Adolescent↗
PubMed2006

Use of the Modified Rankin Scale to assess outcome after arteriovenous malformation radiosurgery.

OBJECTIVE: To present the results of arteriovenous malformation (AVM) radiosurgery using the Modified Rankin Scale (MRS) as the primary outcome measure and to analyze whether previous AVM rupture or other factors have an effect on outcomes after AVM radiosurgery. METHODS: We reviewed outcomes after AVM radiosurgery for 243 patients from 1990 and 2001. The mean follow-up after radiosurgery was 65 months. RESULTS: Forty-one patients (17%) sustained a decline in MRS (median -2) after AVM radiosurgery. We noted a decline in MRS in 4% of patients 1 year after radiosurgery, 8% of patients at 3 years after radiosurgery, and 15% of patients at 7 years after radiosurgery. The radiosurgery-based AVM score correlated with a decline in MRS after AVM radiosurgery in multivariate testing (odds ratio 2.1; 95% CI 1.2 to 3.6; p < 0.01). CONCLUSIONS: Previous AVM rupture did not influence neurologic deterioration after AVM radiosurgery. The radiosurgery-based AVM score predicted the chance of a worse MRS after radiosurgery.

Activities of Daily Living↗
PubMed2006

Stereotactic radiosurgery for brainstem metastases: Survival, tumor control, and patient outcomes.

PURPOSE: Patients with brainstem metastases have limited treatment options. In this study, we reviewed outcomes after stereotactic radiosurgery (SRS) in the management of patients with brainstem metastases. METHODS AND MATERIALS: Records were reviewed of 22 consecutive patients presenting with brainstem metastases who underwent SRS. The most frequent primary malignancy was the lung (n = 11), followed by breast (n = 3) and kidney (n = 2). Three patients (14%) also underwent whole-brain radiation therapy (WBRT). The median tumor volume was 0.9 mL (range, 0.1-3.3 mL); the median tumor margin dose was 16 Gy (range, 14-23 Gy). RESULTS: Median survival time after SRS was 8.5 months. Although local tumor control was achieved in all patients with imaging follow-up (n = 19), 5 patients died from development and progression of new brain metastases. Two patients (9%) had symptom improvement after SRS, whereas 1 patient (5%) developed a new hemiparesis after SRS. CONCLUSIONS: Radiosurgery is safe and provides a high local tumor control rate for patients with small brainstem metastases. Patients with limited systemic disease and good performance status should be strongly considered for SRS.

Adult↗
PubMed2006

MR angiography fusion technique for treatment planning of intracranial arteriovenous malformations.

PURPOSE: To develop an image fusion technique using elliptical centric contrast-enhanced (CE) MR angiography (MRA) and three-dimensional (3D) time-of-flight (TOF) acquisitions for radiosurgery treatment planning of arteriovenous malformations (AVMs). MATERIALS AND METHODS: CE and 3D-TOF MR angiograms with disparate in-plane fields of view (FOVs) were acquired, followed by k-space reformatting to provide equal voxel dimensions. Spatial domain addition was performed to provide a third, fused data volume. Spatial distortion was evaluated on an MRA phantom and provided slice-dependent and global distortion along the three physical dimensions of the MR scanner. In vivo validation was performed on 10 patients with intracranial AVMs prior to their conventional angiogram on the day of gamma knife radiosurgery. RESULTS: Spatial distortion in the phantom within a volume of 14 x 14 x 3.2 cm(3) was less than +/-1 mm (+/-1 standard deviation (SD)) for CE and 3D-TOF data sets. Fused data volumes were successfully generated for all 10 patients. CONCLUSION: Image fusion can be used to obtain high-resolution CE-MRA images of intracranial AVMs while keeping the fiducial markers needed for gamma knife radiosurgery planning. The spatial fidelity of these data is within the tolerance acceptable for daily quality control (QC) purposes and gamma knife treatment planning.

Adult↗
PubMed2006

An evidence-based medicine review of stereotactic radiosurgery.

BACKGROUND: Stereotactic radiosurgery has been increasingly utilized to manage a wide variety of indications including vascular malformations, benign and malignant tumors, and functional disorders. METHODS: Review of the recent literature on stereotactic radiosurgery by evidence-based standards. RESULTS: The vast majority of published papers on stereotactic radiosurgery is of rather poor quality (level 3 or below). Two studies provide level 1 evidence showing an improvement in local tumor control or survival for patients with 1-3 brain metastases having radiosurgery in conjunction with whole brain radiation therapy when compared to patients having whole brain radiation therapy alone. One randomized trial found no improvement in facial pain outcomes for trigeminal neuralgia patients having a longer segment of the nerve irradiated. CONCLUSION: For a variety of reasons it is unlikely that randomized clinical trials will be performed to evaluate the clinical usefulness of stereotactic radiosurgery. Nonetheless, the preponderance of level 3 information supports the role of radiosurgery as either an adjunct or alternative to surgical resection or fractionated radiation therapy.

Cardiovascular Abnormalities↗
PubMed2006

Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience.

OBJECTIVE: Stereotactic radiosurgery is an effective alternative to surgical resection for the majority of patients with vestibular schwannomas (VS). However, after radiosurgery, the imaging characteristics of VSs are variable, and correct interpretation is critical to prevent unnecessary surgery for these patients. METHODS: A retrospective study of 208 consecutive patients with unilateral VS having radiosurgery between March 1990 and December 2001. Thirty (14%) patients had tumors that enlarged at least 2 mm after radiosurgery. The median follow-up after radiosurgery was 56 months (range 24-132 mo). RESULTS: The median time to tumor enlargement was 9 months (5-60 mo). The median volume increase was 75%. A loss of central enhancement was noted in 28 (93%) patients. Six (20%) patients had new symptoms noted at the time of tumor enlargement including hemifacial spasm (n = 2), ataxia (n = 2), trigeminal neuralgia (n = 1), and facial numbness (n = 1). Additional treatment was performed at the time of initial enlargement in 3 patients (resection, n = 2; ventriculoperitoneal shunt, n = 1). In the 28 patients who did not undergo resection at the time of initial enlargement, three patterns were identified on later imaging. Sixteen (57%) patients showed eventual tumor regression (type 1), and eight (29%) patients had tumors that increased and remained larger but did not show progressive enlargement (type 2). Four (14%) patients showed progressive enlargement on serial imaging (type 3) and underwent additional treatment (resection, n = 3; stereotactic radiation therapy, n = 1). CONCLUSION: Tumor expansion after VS radiosurgery rarely denotes a failed procedure, and the majority of patients only require further imaging. Approximately one third of tumors that enlarge will remain increased in size compared with the time of radiosurgery but will not show sequential growth. Additional tumor treatment should be reserved only for patients who demonstrate progressive tumor enlargement on serial imaging (2% in this series).

Adult↗
PubMed2006

Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.

OBJECTIVE: The best management for patients with small- to medium-sized vestibular schwannomas (VS) is controversial. METHODS: : A prospective cohort study of 82 patients with unilateral, unoperated VS less than 3 cm undergoing surgical resection (n = 36) or radiosurgery (n = 46). Patients undergoing resection were younger (48.2 yr versus 53.9 yr, P = 0.03). The groups were similar with regard to hearing loss, associated symptoms, and tumor size. The mean follow-up period was 42 months (range, 12-62 mo). RESULTS: Normal facial movement and preservation of serviceable hearing was more frequent in the radiosurgical group at 3 months (P < 0.001), 1 year (P < 0.001), and at the last follow-up examination (P < 0.01) compared with the surgical resection group. Patients undergoing surgical resection had a significant decline in the following subscales of the Health Status Questionnaire 3 months after surgery: physical functioning (P = 0.006), role-physical (P < 0.001), energy/fatigue (P = 0.02), and overall physical component (P = 0.004). Patients in the surgical resection group continued to have a significant decline in the physical functioning (P = 0.04) and bodily pain (P = 0.04) subscales at 1 year and in bodily pain (P = 0.02) at the last follow-up examination. The radiosurgical group had no decline on any component of the Health Status Questionnaire after the procedure. The radiosurgical group had lower mean Dizziness Handicap Inventory scores (16.5 versus 8.4, P = 0.02) at the last follow-up examination. There was no difference in tumor control (100 versus 96%, P = 0.50). CONCLUSION: Early outcomes were better for VS patients undergoing stereotactic radiosurgery compared with surgical resection (Level 2 evidence). Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.

Cohort Studies↗
PubMed2006

Radiosurgery for arteriovenous malformations in children.

OBJECT: The authors present the results of stereotactic radiosurgery performed in a consecutive series of children with arteriovenous malformations (AVMs) and analyze factors associated with successful radiosurgery for this condition. METHODS: Between 1990 and 2001, 38 patients 18 years of age or younger underwent radiosurgery for AVMs. The median patient age was 15 years; 20 patients (53%) had experienced a prior hemorrhage. Twenty-seven AVMs (71%) were Spetzler-Martin Grade III or higher; 16 patients (42%) had AVMs located in the basal ganglia, thalamus, or brainstem. The median AVM volume was 3.4 cm3. The median radiosurgery-based AVM score was 1.08 according to the following formula: AVM score = 0.1 volume (cm3) + 0.02 x age (years) + 0.3 x location (frontal/temporal = 0; parietal/occipital/corpus callosum/cerebellar = 1; basal ganglia/thalamus/brainstem = 2). The median follow-up period was 42 months. One patient (3%) had an intraventricular hemorrhage 26 months after radiosurgery but experienced no new deficit. No patient had a permanent radiation-related complication after radiosurgery. Twenty-six patients (68%) had excellent outcomes (as defined by complete obliteration of the AVM with no new deficit) after radiosurgical treatment (21 cases determined using angiography and five using magnetic resonance imaging). Twelve patients (32%) remained unchanged (incomplete obliteration but no new deficit). Univariate analysis found that patient age, AVM volume, location, or Spetzler-Martin grade did not correlate with excellent outcomes. Patients whose radiosurgery-based AVM scores were 1 or lower experienced an excellent outcome more frequently than patients with an AVM score higher than 1 (88% compared with 52%, p = 0.03). CONCLUSIONS: Radiosurgery was successful in the treatment of the majority of pediatric patients suffering from AVMs, and morbidity levels were minimal. The radiosurgery-based AVM grading scale accurately predicted these outcomes. Children whose AVMs are obliterated after radiosurgery should undergo repeated angiography after they reach adulthood to rule out the possibility of a recurrent nidus that would expose them to an ongoing risk of hemorrhage.

Adolescent↗
PubMed2005

Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas.

INTRODUCTION: The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. METHODS: Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). RESULTS: No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. CONCLUSIONS: Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit.

Adult↗
PubMed2005

Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia.

OBJECT: Stereotactic radiosurgery (SRS) is commonly performed in patients with trigeminal neuralgia, and numerous investigators have found that facial pain outcomes after this procedure are better for patients in whom prior surgery did not fail. Researchers in some centers claim that the results of SRS are equivalent to posterior fossa exploration (PFE). The goal in this study was to verify that claim. METHODS: Information was retrieved from a prospectively maintained database of patients less than 70 years old with idiopathic trigeminal neuralgia who underwent PFE (55 patients) or SRS (28 patients) as their initial surgery between 1999 and 2004. Of the two groups, patients who underwent radiosurgery were older (60.5 compared with 50.7 years, p<0.001). Microvascular decompression was performed in 49 patients (89%) and partial nerve section was performed in six (11%) in the PFE group. The mean maximum dose for SRS was 89.1 Gy. At a mean follow-up duration of 25.5 months, patients who had undergone PFE were more commonly pain free without medications (75% at 1 year, 72% at 3 years) compared with the patients treated with SRS (59% at 1 and 3 years; p = 0.01). Additional surgery was performed in 10 patients (18%) after PFE, compared with eight patients (29%) after SRS (p = 0.4). Eight patients (15%) had either new facial numbness (six cases) or dysesthesias (two cases) after PFE, whereas 12 (43%) had either new facial numbness (eight cases) or dysesthesias (four cases) after SRS. No correlation was noted between the development of facial numbness and facial pain outcome after PFE (p = 0.37), whereas patients in whom trigeminal dysfunction developed after radiosurgery were more frequently free of pain (p = 0.02). CONCLUSIONS: The results support PFE as a more effective primary surgery than SRS in patients with idiopathic trigeminal neuralgia. Moreover, injury to the trigeminal nerve during PFE is not required to achieve excellent facial pain outcomes.

Cranial Fossa, Posterior↗
PubMed2005

Gamma knife radiosurgery of radiation-induced intracranial tumors: local control, outcomes, and complications.

PURPOSE: To determine local control (LC) and complication rates for patients who underwent radiosurgery for radiation-induced intracranial tumors. METHODS AND MATERIALS: Review of a prospectively maintained database (2,714 patients) identified 16 patients (20 tumors) with radiation-induced tumors treated with radiosurgery between 1990 and 2004. Tumor types included typical meningioma (n=17), atypical meningioma (n=2), and schwannoma (n=1). Median patient age at radiosurgery was 47.5 years (range, 27-70 years). The median tumor margin dose was 16 Gy (range, 12-20 Gy). Median follow-up was 40.2 months (range, 10.8-146.2 months). Time-to-event outcomes were calculated with Kaplan-Meier estimates. RESULTS: Three-year and 5-year LC rates were 100%. Three-year and 5-year overall survival rates were 92% and 80%, respectively. Cause-specific survival rates at 3 and 5 years were 100%. Three patients died: 1 had in-field progression 65.1 months after radiosurgery and later died of the tumor, 1 died of progression of a preexisting brain malignancy, and 1 died of an unrelated cause. One patient had increased seizure activity that correlated with development of edema seen on neuroimaging. CONCLUSIONS: LC, survival, and complication rates in our series are comparable to those in previous reports of radiosurgery for intracranial meningiomas. Also, LC rates with radiosurgery are at least comparable to those of surgical series for radiation-induced meningiomas. Radiosurgery is a safe and effective treatment option for radiation-induced intracranial tumors, most of which are typical meningiomas.

Adult↗
PubMed2005

Repeat radiosurgery for idiopathic trigeminal neuralgia.

PURPOSE: Although frequently performed, the efficacy and safety of repeat trigeminal neuralgia radiosurgery is not well described. METHODS AND MATERIALS: Between August 1997 and December 2002, 19 patients (9 men, 10 women) underwent repeat trigeminal neuralgia radiosurgery. The median interval between procedures was 16 months. The median dose (based on an output factor of 0.87 for the 4-mm collimator) for repeat radiosurgery was 76.1 Gy; the median additive dose was 163.1 Gy. Outcomes were defined as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50% pain reduction), and poor. Median follow-up was 24 months. RESULTS: Outcomes after repeat radiosurgery were excellent (n = 14, 74%), good (n = 1, 5%), fair (n = 3, 16%), and poor (n = 1, 5%). Two patients had recurrent pain at 7 and 22 months; 71% and 61% of patients had an excellent outcome at 1- and 2-years after radiosurgery, respectively. Eleven patients (58%) described facial parathesias (n = 3), numbness (n = 5) or dyesthesias (n = 3). Two patients (11%) developed corneal numbness. Nine of 11 patients (82%) with new trigeminal deficits had excellent outcomes at last follow-up compared with 3 of 8 patients (38%) with unchanged facial sensation (p = 0.07). CONCLUSIONS: Repeat trigeminal neuralgia radiosurgery at the dosage described has better facial pain outcomes than primary radiosurgery. However, because the procedure is nonselective and the rate of bothersome numbness was relatively high (16%), dose reduction is recommended to reduce the morbidity of repeat trigeminal neuralgia radiosurgery.

Adult↗
PubMed2005

Radiosurgery for cranial base chordomas and chondrosarcomas.

OBJECTIVE: To evaluate the efficacy and toxicity of radiosurgery in the treatment of cranial base chordoma and chondrosarcoma. METHODS: We reviewed 29 patients with cranial base chordoma (n = 25) or chondrosarcoma (n = 4) who underwent stereotactic radiosurgery between September 1990 and December 2002. The median patient age was 45 years (range, 10-81 yr). Nineteen patients also had radiation therapy before or in conjunction with radiosurgery (median dose, 50.4 Gy). The median tumor volume was 14.4 cm3 (range, 0.6-65.1 cm3). The median tumor margin dose was 15 Gy (range, 10-20 Gy); the median maximum radiation dose was 30 Gy (range, 20-40 Gy). Median clinical and imaging follow-up periods were 4.8 and 4.5 years, respectively. RESULTS: Seven chordoma patients (28%) had tumor progression (in-field, n = 3; out-of-field, n = 4), whereas 18 had stable disease or tumor shrinkage. No patient with a chondroid chordoma had tumor enlargement. The actuarial tumor control rates were 89 and 32% at 2 and 5 years, respectively. All 4 patients with chondrosarcoma had tumor control. Clinically, 7 patients (24%) had improvement of pretreatment symptoms, 16 (55%) remained stable, and 6 (21%) worsened. Three patients with tumor progression died. Ten patients (34%) had radiation-related complications. Complications included cranial nerve deficits (n = 6), radiation necrosis (n = 5), and pituitary dysfunction (n = 3). Patients having radiosurgery alone had no toxicity. CONCLUSION: Cranial base chordomas and chondrosarcomas remain a formidable management challenge. Radiosurgery as an adjunct to surgical resection provides in-field tumor control for some patients, but radiation-related complications are relatively high, especially when radiosurgery is combined with fractionated radiation therapy.

Chondrosarcoma↗
PubMed2005

A prospective study of quality of life in adults with newly diagnosed high-grade gliomas: the impact of the extent of resection on quality of life and survival.

OBJECTIVE: To describe the quality of life (QOL) over time for adults with newly diagnosed high-grade gliomas and to examine the relationship between QOL and outcome data collected in three prospective cooperative group clinical trials. METHODS: The QOL study was a companion protocol for three Phase II high-grade glioma protocols. Five self-administered forms were completed by patients to assess QOL at study entry, 2 months, and 4 months after enrollment. RESULTS: QOL data were available for baseline, first, and second subsequent follow-up evaluations for 89%, 71%, and 69% of patients, respectively. A significant proportion of patients (47.1%) experienced impaired QOL (QOL < or = 50) in at least one measure at subsequent evaluations, whereas most patients (88%) with impaired QOL at baseline continued to have impaired QOL at subsequent evaluations. On multivariable analyses, baseline QOL measures were predictive of QOL at the time of follow-up. In addition, patients who underwent a gross total resection were much less likely to have impaired QOL (P = 0.006), were less likely to experience worsening depression (P = 0.0008), and were more likely to have improved QOL (P = 0.003) at their first follow-up evaluation. Changes in QOL measures over time were not found to be associated with survival in multivariable analyses that adjusted for known prognostic variables; variables that were independently associated with improved survival were better performance status (P < 0.001), younger age (P < 0.001), and greater extent of resection (P < 0.001). CONCLUSION: Baseline QOL was predictive of QOL over time. Gross total resection was associated with longer survival and improved QOL over time for patients with high-grade gliomas.

Adult↗
PubMed2005

Percutaneous retrogasserian glycerol rhizotomy for patients with idiopathic trigeminal neuralgia: a prospective analysis of factors related to pain relief.

OBJECT: The goal of this study was to analyze prospectively factors associated with facial pain outcomes after percutaneous retrogasserian glycerol rhizotomy (PRGR) for patients with medically unresponsive idiopathic trigeminal neuralgia. METHODS: Between July 1999 and December 2003, 98 patients underwent PRGR in the manner described by Håkanson. The mean patient age was 72.1 years and the average pain duration prior to PRGR was 8.6 years. Fifty patients (51%) had previously undergone surgery. In six patients (6%), the trigeminal cistern could not be defined and the procedure was aborted; six patients were lost to follow-up review. An excellent facial pain outcome was defined as the absence of facial pain without medications. Thirty-two (35%) of 92 patients either received no benefit (17 patients) or experienced recurrent pain (15 patients) and required additional surgery at a mean of 7.5 months after PRGR; the mean duration of follow-up review in the other 60 patients was 28.7 months (range 3-52 months). Including patients who did not receive a glycerol injection, the 1- and 3-year chances of an excellent facial pain outcome were 61 and 50%, respectively. A multivariate analysis of clinical and surgical factors showed that the facial pain exhibited on glycerol injection correlated with excellent facial pain outcomes (relative risk [RR] = 1.02; 95% confidence interval [CI] 0.26-1.77; p < 0.01), whereas patients who experienced any constant pain less frequently had excellent outcomes (RR = 1.13; 95% CI 0.06-2.20; p = 0.04). Forty-six patients (53%) experienced either mild numbness/parathesias (39 patients) or dysesthesias (seven patients). New trigeminal deficits after PRGR were associated with excellent facial pain outcomes (RR = 1.25; 95% CI 0.56-1.93; p < 0.001). CONCLUSIONS: Percutaneous retrogasserian glycerol rhizotomy remains a good operation for patients with medically unresponsive trigeminal neuralgia who are considered poor candidates for posterior fossa exploration. Predictive factors for success include patients without any constant facial pain, patients with immediate facial pain during glycerol injection, and patients with new trigeminal deficits after PRGR.

Aged↗
PubMed2005

Natural history, evaluation, and management of intracranial vascular malformations.

Intracranial vascular malformations are seen increasingly in clinical practice, primarily because of advances in cross-sectional brain and spinal cord imaging. Commonly encountered lesion types include arteriovenous malformations, cavernous malformations, venous malformations, dural arteriovenous fistulas, and capillary telangiectasias. Patients can experience various symptoms and signs at presentation. The natural history of vascular malformations depends on lesion type, location, size, and overall hemodynamics. The natural history for each lesion subtype is reviewed, with special consideration of the risk of hemorrhage or other adverse outcomes after the lesion is detected and any known predictors of hemorrhage or other outcomes. In practice, these data are compared with the risk of available treatment options as the optimal management is clarified. A multidisciplinary approach including neurosurgery, radiosurgery, interventional neuroradiology, and vascular neurology is most useful in determining the best management strategy.

Arteriovenous Fistula↗
PubMed2005

Tumefactive cysts: a delayed complication following radiosurgery for cerebral arterial venous malformations.

We report five cases of symptomatic delayed cyst formation after radiosurgery for intracranial arterial venous malformations. Median time to discovery of the cysts following most recent radiosurgery was 59 months (range, 34-89 months). In all five patients, the radiation therapy-induced cysts exhibited tumefactive characteristics, including vasogenic edema, mass effect, and nodular enhancement. Despite these malignant features, these cystic lesions should be recognized as a benign complication of radiosurgery so that proper treatment (i.e., cystoperitoneal shunt surgery or excision) can be initiated.

Adult↗