EP27 Vein of galen aneurysmal malformation (VGAM) – literature review of the outcome data after neuro-interventional treatment

Abstract

endovascular procedures. Background Radiosurgery is an effective treatment for brain AVM, nonetheless delayed radiation-induced complications remain a significant problem, especially for late cerebral radiation necrosis, that usually occurs within 3 years after radiosurgical treatment. In the recent past, endovascular treatment by using liquid embolic materials has been extensively used to reduce the size of large AVM prior to Radiosurgery. Methods From 2008 to 2018, 414 AVMs were treated with Gamma Knife in our hospital. 36 out of 414 AVMs underwent at least 2 endovascular treatments in adjunct to the radiosurgical treatment. A follow-up of at least 3 years was available for all these patients. Results Five patients developed late symptomatic cerebral radionecrosis; in three patients, post-irradiative cystic formation with mass effect and signs of hemorrhage was found and two patients developed edematous solid mass lesions. Conclusions A relevant percentage (5 out of 36 = 14%) of patients that received at least two endovascular plus radiosurgery treatments developed subsequent radiation necrosis This series highlights the need for a defined strategy prior to initiation of treatment in brain AVMs and shows how repeated endovascular procedures in addition to radiosurgery can play a cumulative role in the development of late radionecrosis and cystic formations.