{"@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/1361699994412756608.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.3171/2011.9.jns11176"}},{"identifier":{"@type":"URI","@value":"https://thejns.org/view/journals/j-neurosurg/116/1/article-p44.xml"}},{"identifier":{"@type":"URI","@value":"https://thejns.org/downloadpdf/journals/j-neurosurg/116/1/article-p44.xml"}}],"dc:title":[{"@value":"Stereotactic radiosurgery for arteriovenous malformations, Part 5: management of brainstem arteriovenous malformations"}],"dcterms:alternative":[{"@value":"Clinical article"}],"description":[{"type":"abstract","notation":[{"@value":"<jats:sec>\n<jats:title>Object</jats:title>\n<jats:p>In this paper, the authors' goal was to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the medulla, pons, and midbrain.</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; 67 patients had AVMs in the brainstem. In this series, 51 patients (76%) had a prior hemorrhage. The median target volume was 1.4 cm<jats:sup>3</jats:sup> (range 0.1–13.4 cm<jats:sup>3</jats:sup>). The median margin dose was 20 Gy (range 14–25.6 Gy).</jats:p></jats:sec>\n<jats:sec>\n<jats:title>Results</jats:title>\n<jats:p>Obliteration of the AVMs was eventually documented in 35 patients at a median follow-up of 73 months (range 6–269 months). The actuarial rates of documentation of total obliteration were 41%, 70%, 70%, and 76% at 3, 4, 5, and 10 years, respectively. Higher rates of AVM obliteration were associated only with a higher margin dose. Four patients (6%) suffered a hemorrhage during the latency period, and 2 patients died. The rate of AVM hemorrhage after SRS was 3.0%, 3.0%, and 5.8% at 1, 5, and 10 years, respectively. The overall annual hemorrhage rate was 1.9%. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 7 patients (10%) after SRS, and a delayed cyst developed in 2 patients (3%). One patient died at an outside institution with symptoms of AREs and unrecognized hydrocephalus. Higher 12-Gy volumes and higher Spetzler-Martin grades were associated with a higher risk of symptomatic AREs. Ten of 22 patients who had ocular dysfunction before SRS had improvement, 9 were unchanged, and 3 were worse due to AREs. Eight of 14 patients who had hemiparesis before SRS improved, 5 were unchanged, and 1 was worse.</jats:p></jats:sec>\n<jats:sec>\n<jats:title>Conclusions</jats:title>\n<jats:p>Although hemorrhage after obliteration did not occur in this series, patients remained at risk during the latency interval until obliteration occurred. Thirty-eight percent of the patients who had neurological deficits due to prior hemorrhage improved. Higher dose delivery in association with conformal and highly selective SRS is required for safe and effective radiosurgery.</jats:p></jats:sec>"}]}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1381699994412756608","@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/1381699994412756610","@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/1381699994412756615","@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/1381699994412756609","@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/1381699994412756613","@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/1381699994412756612","@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/1381699994412756611","@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"}]},{"@id":"https://cir.nii.ac.jp/crid/1381699994412756614","@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"}]}],"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":"44","prism:endingPage":"53"},"reviewed":"false","url":[{"@id":"https://thejns.org/view/journals/j-neurosurg/116/1/article-p44.xml"},{"@id":"https://thejns.org/downloadpdf/journals/j-neurosurg/116/1/article-p44.xml"}],"createdAt":"2011-11-11","modifiedAt":"2023-03-27","relatedProduct":[{"@id":"https://cir.nii.ac.jp/crid/1360298755646250752","@type":"Article","resourceType":"学術雑誌論文(journal article)","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@value":"In Reply: 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/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/1360846645506718592","@type":"Article","resourceType":"学術雑誌論文(journal article)","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@value":"Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern"}]},{"@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/1390282680034407936","@type":"Article","resourceType":"学術雑誌論文(journal article)","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@language":"en","@value":"Long-term Outcomes of Gamma Knife Surgery for Posterior Fossa Arteriovenous Malformations"}]},{"@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.jns11176"},{"@type":"CROSSREF","@value":"10.2176/nmc.oa.2013-0090_references_DOI_7mARa91OU2nTXSO2zDlVspLd90h"},{"@type":"CROSSREF","@value":"10.1227/neu.0000000000002279_references_DOI_7mARa91OU2nTXSO2zDlVspLd90h"},{"@type":"CROSSREF","@value":"10.1227/neu.0000000000002064_references_DOI_7mARa91OU2nTXSO2zDlVspLd90h"},{"@type":"CROSSREF","@value":"10.7887/jcns.33.27_references_DOI_7mARa91OU2nTXSO2zDlVspLd90h"},{"@type":"CROSSREF","@value":"10.3171/2015.12.jns152190_references_DOI_7mARa91OU2nTXSO2zDlVspLd90h"},{"@type":"CROSSREF","@value":"10.2335/scs.53.369_references_DOI_7mARa91OU2nTXSO2zDlVspLd90h"}]}