{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1360298762163435904.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.3171/2011.9.jns11175"}},{"identifier":{"@type":"URI","@value":"https://thejns.org/view/journals/j-neurosurg/116/1/article-p33.xml"}},{"identifier":{"@type":"URI","@value":"https://thejns.org/downloadpdf/journals/j-neurosurg/116/1/article-p33.xml"}}],"dc:title":[{"@value":"Stereotactic radiosurgery for arteriovenous malformations, Part 4: management of basal ganglia and thalamus arteriovenous malformations"}],"dcterms:alternative":[{"@value":"Clinical article"}],"description":[{"type":"abstract","notation":[{"@value":"<jats:sec>\n<jats:title>Object</jats:title>\n<jats:p>The authors conducted a study to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the basal ganglia and thalamus.</jats:p></jats:sec>\n<jats:sec>\n<jats:title>Methods</jats:title>\n<jats:p>Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 56 patients had AVMs of the basal ganglia and 77 had AVMs of the thalamus. In this series, 113 (85%) of 133 patients had a prior hemorrhage. The median target volume was 2.7 cm<jats:sup>3</jats:sup> (range 0.1–20.7 cm<jats:sup>3</jats:sup>) and the median margin dose was 20 Gy (range 15–25 Gy).</jats:p></jats:sec>\n<jats:sec>\n<jats:title>Results</jats:title>\n<jats:p>Obliteration of the AVM eventually was documented on MR imaging in 78 patients and on angiography in 63 patients in a median follow-up period of 61 months (range 2–265 months). The actuarial rates documenting total obliteration after radiosurgery were 57%, 70%, 72%, and 72% at 3, 4, 5, and 10 years, respectively. Factors associated with a higher rate of AVM obliteration included AVMs located in the basal ganglia, a smaller target volume, a smaller maximum diameter, and a higher margin dose. Fifteen (11%) of 133 patients suffered a hemorrhage during the latency period and 7 patients died. The rate of post-SRS AVM hemorrhage was 4.5%, 6.2%, 9.0%, 11.2%, and 15.4% at 1, 2, 3, 5, and 10 years, respectively. The overall annual hemorrhage rate was 4.7%. When 5 patients with 7 hemorrhages occurring earlier than 6 months after SRS were removed from this analysis, the annual hemorrhage rate decreased to 2.7%. Larger volume AVMs had a higher risk of hemorrhage after SRS. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 6 patients (4.5%), and in 1 patient a delayed cyst developed 56 months after SRS. No patient died of AREs. Factors associated with a higher risk of symptomatic AREs were larger target volume, larger maximum diameter, lower margin dose, and a higher Pollock-Flickinger score.</jats:p></jats:sec>\n<jats:sec>\n<jats:title>Conclusions</jats:title>\n<jats:p>Stereotactic radiosurgery is a gradually effective and relatively safe management option for deep-seated AVMs in the basal ganglia and thalamus. Although hemorrhage after obliteration did not occur in the present series, patients remain at risk during the latency interval between SRS and obliteration. The best candidates for SRS are patients with smaller volume AVMs located in the basal ganglia.</jats:p></jats:sec>"}]}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1380298762163435909","@type":"Researcher","foaf:name":[{"@value":"Hideyuki Kano"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435905","@type":"Researcher","foaf:name":[{"@value":"Douglas Kondziolka"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435911","@type":"Researcher","foaf:name":[{"@value":"Huai-che Yang"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"},{"@value":"Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435910","@type":"Researcher","foaf:name":[{"@value":"John C. Flickinger"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Radiation Oncology, and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435904","@type":"Researcher","foaf:name":[{"@value":"Thomas J. Flannery"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435908","@type":"Researcher","foaf:name":[{"@value":"Ajay Niranjan"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435907","@type":"Researcher","foaf:name":[{"@value":"L. Dade Lunsford"}],"jpcoar:affiliationName":[{"@value":"Departments of Neurological Surgery and"},{"@value":"Radiation Oncology, and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]},{"@id":"https://cir.nii.ac.jp/crid/1380298762163435906","@type":"Researcher","foaf:name":[{"@value":"Josef Novotny"}],"jpcoar:affiliationName":[{"@value":"Radiation Oncology, and"},{"@value":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"00223085"},{"@type":"EISSN","@value":"19330693"}],"prism:publicationName":[{"@value":"Journal of Neurosurgery"}],"dc:publisher":[{"@value":"Journal of Neurosurgery Publishing Group (JNSPG)"}],"prism:publicationDate":"2012-01","prism:volume":"116","prism:number":"1","prism:startingPage":"33","prism:endingPage":"43"},"reviewed":"false","url":[{"@id":"https://thejns.org/view/journals/j-neurosurg/116/1/article-p33.xml"},{"@id":"https://thejns.org/downloadpdf/journals/j-neurosurg/116/1/article-p33.xml"}],"createdAt":"2011-11-11","modifiedAt":"2023-03-27","relatedProduct":[{"@id":"https://cir.nii.ac.jp/crid/1360298757437770368","@type":"Article","resourceType":"学術雑誌論文(journal article)","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@value":"Stereotactic Radiosurgery Provides Long-Term Safety for Patients With Arteriovenous Malformations in the Diencephalon and Brainstem: The Optimal Dose Selection and Long-Term Outcomes"}]},{"@id":"https://cir.nii.ac.jp/crid/1390025485942160256","@type":"Article","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@language":"ja","@value":"脳動静脈奇形に対するガンマナイフ治療の適応・最新の治療成績と今後の治療戦略"},{"@language":"en","@value":"Gamma Knife Radiosurgery for AVM: Indication, Current Outcomes, and Future Treatment Strategies"}]},{"@id":"https://cir.nii.ac.jp/crid/1390865574478570496","@type":"Article","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@language":"en","@value":"Update on Gamma Knife Radiosurgery for Arteriovenous Malformations"},{"@language":"ja","@value":"脳動静脈奇形に対するガンマナイフの現状"}]}],"dataSourceIdentifier":[{"@type":"CROSSREF","@value":"10.3171/2011.9.jns11175"},{"@type":"CROSSREF","@value":"10.1227/neu.0000000000002064_references_DOI_2KQ8FSsMzwaoeXYqyiHpzb6GHMH"},{"@type":"CROSSREF","@value":"10.7887/jcns.33.27_references_DOI_2KQ8FSsMzwaoeXYqyiHpzb6GHMH"},{"@type":"CROSSREF","@value":"10.2335/scs.53.369_references_DOI_2KQ8FSsMzwaoeXYqyiHpzb6GHMH"}]}