Eficacia de la radiocirugía estereotáctica en pacientes con malformaciones arteriovenosas cerebrales previamente embolizadas tratados en el Gamma Knife Center durante el periodo del 2015-2019.

Abstract

Cerebral arteriovenous malformations represent one of the greatest challenges that neurosurgeons face in the daily practice of their profession. These structural abnormalities affect all components of the cerebral vasculature. The variety of its symptoms depends of the location of the lesion within the central nervous system. The structural complexity of the lesion and its behavior means that the treatment of the vascular malformations is multidisciplinary, ranging from conventional craniotomy to less invasive methods such as stereotactic radiosurgery. General Objective: The general objective of this study was to demonstrate the efficacy of the combine treatment of stereotactic radiosurgery with Gamma Knife in combination with endovascular embolization in patients with cerebral arteriovenous malformations. Material and methods: A retrospective longitudinal study was carried out among patients treated at the Gamma Knife Center of the Clínica Alcivar from 2015 to 2019 with follow-up 6 to 12 months after the intervention, the sample of this study consisted of 77 patients who underwent stereotactic radiosurgery with gamma knife between the years 2015 and 2019. Results: 33.8% of the patients presented bleeding at the time of diagnosis while 66.2% did not, in the 6-month control it was found that 40.3% of patients presented improvement of the symptoms while 33.8% had sporadic headaches and 14.3% were asymptomatic. In the 12-month control, the percentage of patients with symptom improvement increased to 36.4%. Conclusions: Patients with arteriovenous malformations who do not present bleeding prior to the intervention present better imaging results after treatment with stereotactic radiosurgery with Gamma Knife than those with ruptured malformations with statistical significance.