Multimodal management of arteriovenous malformations of the basal ganglia and thalamus: factors affecting obliteration and outcome

Abstract

Objective: Arteriovenous malformations (AVMs) of the basal ganglia and thalamus are particularly difficult lesions to treat, accounting for 3%-13% of all AVMs in surgical series and 23%-44% of malformations in radiosurgery series. The goal of this study was to report the results of multimodal management of basal ganglia and thalamic AVMs and investigate the factors that influence radiographic cure and good clinical outcomes.

Methods: This study was a retrospective analysis of a prospectively maintained database of all patients treated at the authors' institution. Clinical, radiological, follow-up, and outcome data were analyzed. Univariate and multivariate analyses were conducted to explore the influence of various factors on outcome.

Results: The results and data analysis pertaining to 123 patients treated over 32 years are presented. In this cohort, radiographic cure was achieved in 50.9% of the patients. Seventy-five percent of patients had good clinical outcomes (stable or improved performance scores), whereas 25% worsened after treatment. Inclusion of surgery and radiosurgery independently predicted obliteration, whereas nidus diameter and volume predicted clinical outcomes. Nidus volume/diameter and inclusion of surgery predicted the optimal outcome, i.e., good clinical outcomes with lesion obliteration.

Conclusions: Good outcomes are possible with multimodal treatment in these complex patients. Increasing size and, by extension, higher Spetzler-Martin grade are associated with worse outcomes. Inclusion of multiple modalities of treatment as indicated could improve the chances of radiographic cure and good outcomes.

Keywords: AVM = arteriovenous malformation; BGT = basal ganglia and thalamus; EVT = endovascular treatment; GKS = Gamma Knife surgery; LINAC = linear accelerator; PostTP = posttreatment period; PreTP = pretreatment period; SRS = stereotactic radiosurgery; arteriovenous malformation; basal ganglia; mRS = modified Rankin Scale; microsurgery; multimodal treatment; radiosurgery; thalamus; vascular disorders.