Citation Information :
Kumar A, Bhatia V, khandelwal N, Gupta SK. Endovascular Embolization of Fistulous Component of Gamma Knife-treated Arteriovenous Malformation in a Patient Presenting with Delayed Hemorrhage. J Postgrad Med Edu Res 2019; 53 (2):91-93.
Aim: The rationale basis for treatment of cerebral arteriovenous malformation is total obliteration of the arteriovenous malformation (AVM) with normalization of cerebral vasculature and flow hemodynamics. Presence of fistulous component has been identified as one of the causes of failure of gamma knife therapy in these cases.
Case report: We present a case where the patient presented with rebleed due to associated fistulous component which was then subsequently succesfully treated with endovascular embolisation.
Steiner L, Lindquist C, Adler JR, et al. Clinical outcome of radiosurgery for cerebral arteriovenous malformations. J Neurosurg 1992;77:1-8.
Lunsford LD, Kondziolka JI, Marks MP, et al. Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 1991;75:512–514.
Gallina P, Merienne L, Meder JF, et al. Failure in radiosurgery treatment of cerebral arteriovenous malformation. Neurosurgery 1998;42: 996-1004
Luo CB, Guo WY, Teng MM, et al. Embolization of arteriovenous fistula after radiosurgery for multiple cerebral arteriovenous malformations. Kaohsiung J Med Sci 2005;21:571e7
Mukherjee KK, Kumar N, Tripathi M, et al. Dose fractionated gamma knife radiosurgery for large arteriovenous malformations on daily or alternate day schedule outside the linear quadratic model: Proof of concept and early results. A substitute to volume fractionation. Neurol India 2017;65:826-835
Pollock BE, Kondziolka D, Lunsford LD, et al. Repeated stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. Neurosurgery 1996;38:318e24
Luo CB, Guo WY, Teng MMH, et al. Fistula components of brain arteriovenous malformations: angioarchitecture analysis and embolisation prior to Gamma-Knife surgery. J Chin Med Assoc 2013;76:277-281
Luo CB, Guo WY, Teng MM, et al. Embolisation of arteriovenous fistula after radiosurgery for multiple cerebral arteriovenous malformations. Kaohsiung J Med Sci 2005;21:571-577
Pollock BE, Kondziolka D, Lunsford LD, et al. Repeat stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. Neurosurgery 1996;38:318-324.
Luo CB, Teng MMH, Chang FC, et al. Endovascular treatment of intracranial high-flow arteriovenous fistulas by Guglielmi detachable coils. J Chin Med Assoc 2006;69:80e5.
Panagiotopoulos V, Gizewski E, Asgari S, et al. Embolization of intracranial arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx). AJNR Am J Neuroradiol 2009;30:99-106.
