Radiosurgical techniques and clinical outcomes of gamma knife radiosurgery for brainstem arteriovenous malformations
Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures. Complete obliteration of the nidus is not always possible. We describe over 20 years of radiosurgical procedures for brainstem AVMs, focusing on...
Saved in:
Published in | Journal of Korean Neurosurgical Society Vol. 52; no. 6; pp. 534 - 540 |
---|---|
Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Korea (South)
The Korean Neurosurgical Society
01.12.2012
대한신경외과학회 |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures. Complete obliteration of the nidus is not always possible. We describe over 20 years of radiosurgical procedures for brainstem AVMs, focusing on clinical outcomes and radiosurgical techniques.
Between 1992 and 2011, the authors performed gamma knife radiosurgery (GKRS) in 464 cerebral AVMs. Twenty-nine of the 464 patients (6.3%) reviewed had brainstem AVMs. This series included sixteen males and thirteen females with a mean age of 30.7 years (range : 5-71 years). The symptoms that led to diagnoses were as follows : an altered mentality (5 patients, 17.3%), motor weakness (10 patients, 34.5%), cranial nerve symptoms (3 patients, 10.3%), headache (6 patients, 20.7%), dizziness (3 patients, 10.3%), and seizures (2 patients, 6.9%). Two patients had undergone a previous nidus resection, and three patients had undergone a previous embolization. Twenty-four patients underwent only GKRS. With respect to the nidus type and blood flow, the ratio of compact type to diffuse type and high flow to low flow were 17 : 12 and 16 : 13, respectively. In this series, 24 patients (82.8%) had a prior hemorrhage. The mean target volume was 1.7 cm(3) (range 0.1-11.3 cm(3)). The mean maximal and marginal radiation doses were 38.5 Gy (range 28.6-43.6 Gy) and 23.4 Gy (range 18-27 Gy), and the mean isodose profile was 61.3% (range 50-70%).
Twenty-four patients had brainstem AVMs and were followed for more than 3 years. Obliteration of the AVMs was eventually documented in 17 patients (70.8%) over a mean follow-up period of 77.5 months (range 36-216 months). With respect to nidus type and blood flow, the obliteration rate of compact types (75%) was higher than that of diffuse types (66.7%), and the obliteration rate of low flow AVMs (76.9%) was higher than that of high flow AVMs (63.6%) (p<0.05). Two patients (6.9%) with three hemorrhagic events suffered a hemorrhage during the follow-up period. The annual bleeding rate of AVM after GKRS was 1.95% per year. No adverse radiation effects or delayed cystic formations were found.
GKRS has an important clinical role in treatment of brainstem AVMs, which carry excessive surgical risks. Angiographic features and radiosurgical techniques using a lower maximal dose with higher isodose profiles are important for lesion obliteration and the avoidance of complications. |
---|---|
AbstractList | Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures. Complete obliteration of the nidus is not always possible. We describe over 20 years of radiosurgical procedures for brainstem AVMs, focusing on clinical outcomes and radiosurgical techniques.
Between 1992 and 2011, the authors performed gamma knife radiosurgery (GKRS) in 464 cerebral AVMs. Twenty-nine of the 464 patients (6.3%) reviewed had brainstem AVMs. This series included sixteen males and thirteen females with a mean age of 30.7 years (range : 5-71 years). The symptoms that led to diagnoses were as follows : an altered mentality (5 patients, 17.3%), motor weakness (10 patients, 34.5%), cranial nerve symptoms (3 patients, 10.3%), headache (6 patients, 20.7%), dizziness (3 patients, 10.3%), and seizures (2 patients, 6.9%). Two patients had undergone a previous nidus resection, and three patients had undergone a previous embolization. Twenty-four patients underwent only GKRS. With respect to the nidus type and blood flow, the ratio of compact type to diffuse type and high flow to low flow were 17 : 12 and 16 : 13, respectively. In this series, 24 patients (82.8%) had a prior hemorrhage. The mean target volume was 1.7 cm(3) (range 0.1-11.3 cm(3)). The mean maximal and marginal radiation doses were 38.5 Gy (range 28.6-43.6 Gy) and 23.4 Gy (range 18-27 Gy), and the mean isodose profile was 61.3% (range 50-70%).
Twenty-four patients had brainstem AVMs and were followed for more than 3 years. Obliteration of the AVMs was eventually documented in 17 patients (70.8%) over a mean follow-up period of 77.5 months (range 36-216 months). With respect to nidus type and blood flow, the obliteration rate of compact types (75%) was higher than that of diffuse types (66.7%), and the obliteration rate of low flow AVMs (76.9%) was higher than that of high flow AVMs (63.6%) (p<0.05). Two patients (6.9%) with three hemorrhagic events suffered a hemorrhage during the follow-up period. The annual bleeding rate of AVM after GKRS was 1.95% per year. No adverse radiation effects or delayed cystic formations were found.
GKRS has an important clinical role in treatment of brainstem AVMs, which carry excessive surgical risks. Angiographic features and radiosurgical techniques using a lower maximal dose with higher isodose profiles are important for lesion obliteration and the avoidance of complications. Objective : Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures. Complete obliteration of the nidus is not always possible. We describe over 20 years of radiosurgical procedures for brainstem AVMs, focusing on clinical outcomes and radiosurgical techniques. Methods : Between 1992 and 2011, the authors performed gamma knife radiosurgery (GKRS) in 464 cerebral AVMs. Twenty-nine of the 464 patients (6.3%) reviewed had brainstem AVMs. This series included sixteen males and thirteen females with a mean age of 30.7 years (range : 5-71 years). The symptoms that led to diagnoses were as follows : an altered mentality (5 patients, 17.3%), motor weakness (10 patients, 34.5%), cranial nerve symptoms (3 patients, 10.3%), headache (6 patients, 20.7%), dizziness (3 patients, 10.3%), and seizures (2 patients, 6.9%). Two patients had undergone a previous nidus resection, and three patients had undergone a previous embolization. Twenty-four patients underwent only GKRS. With respect to the nidus type and blood flow, the ratio of compact type to diffuse type and high flow to low flow were 17 : 12 and 16 : 13, respectively. In this series, 24 patients (82.8%) had a prior hemorrhage. The mean target volume was 1.7 cm3 (range 0.1-11.3 cm3). The mean maximal and marginal radiation doses were 38.5 Gy (range 28.6-43.6 Gy) and 23.4 Gy (range 18-27 Gy), and the mean isodose profile was 61.3% (range 50-70%). Results : Twenty-four patients had brainstem AVMs and were followed for more than 3 years. Obliteration of the AVMs was eventually documented in 17 patients (70.8%) over a mean follow-up period of 77.5 months (range 36-216 months). With respect to nidus type and blood flow, the obliteration rate of compact types (75%) was higher than that of diffuse types (66.7%), and the obliteration rate of low flow AVMs (76.9%) was higher than that of high flow AVMs (63.6%) (p<0.05). Two patients (6.9%) with three hemorrhagic events suffered a hemorrhage during the follow-up period. The annual bleeding rate of AVM after GKRS was 1.95% per year. No adverse radiation effects or delayed cystic formations were found. Conclusion : GKRS has an important clinical role in treatment of brainstem AVMs, which carry excessive surgical risks. Angiographic features and radiosurgical techniques using a lower maximal dose with higher isodose profiles are important for lesion obliteration and the avoidance of complications. KCI Citation Count: 11 OBJECTIVEBrainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures. Complete obliteration of the nidus is not always possible. We describe over 20 years of radiosurgical procedures for brainstem AVMs, focusing on clinical outcomes and radiosurgical techniques. METHODSBetween 1992 and 2011, the authors performed gamma knife radiosurgery (GKRS) in 464 cerebral AVMs. Twenty-nine of the 464 patients (6.3%) reviewed had brainstem AVMs. This series included sixteen males and thirteen females with a mean age of 30.7 years (range : 5-71 years). The symptoms that led to diagnoses were as follows : an altered mentality (5 patients, 17.3%), motor weakness (10 patients, 34.5%), cranial nerve symptoms (3 patients, 10.3%), headache (6 patients, 20.7%), dizziness (3 patients, 10.3%), and seizures (2 patients, 6.9%). Two patients had undergone a previous nidus resection, and three patients had undergone a previous embolization. Twenty-four patients underwent only GKRS. With respect to the nidus type and blood flow, the ratio of compact type to diffuse type and high flow to low flow were 17 : 12 and 16 : 13, respectively. In this series, 24 patients (82.8%) had a prior hemorrhage. The mean target volume was 1.7 cm(3) (range 0.1-11.3 cm(3)). The mean maximal and marginal radiation doses were 38.5 Gy (range 28.6-43.6 Gy) and 23.4 Gy (range 18-27 Gy), and the mean isodose profile was 61.3% (range 50-70%). RESULTSTwenty-four patients had brainstem AVMs and were followed for more than 3 years. Obliteration of the AVMs was eventually documented in 17 patients (70.8%) over a mean follow-up period of 77.5 months (range 36-216 months). With respect to nidus type and blood flow, the obliteration rate of compact types (75%) was higher than that of diffuse types (66.7%), and the obliteration rate of low flow AVMs (76.9%) was higher than that of high flow AVMs (63.6%) (p<0.05). Two patients (6.9%) with three hemorrhagic events suffered a hemorrhage during the follow-up period. The annual bleeding rate of AVM after GKRS was 1.95% per year. No adverse radiation effects or delayed cystic formations were found. CONCLUSIONGKRS has an important clinical role in treatment of brainstem AVMs, which carry excessive surgical risks. Angiographic features and radiosurgical techniques using a lower maximal dose with higher isodose profiles are important for lesion obliteration and the avoidance of complications. |
Author | Choi, Hyuk Jai Choi, Seok Keun Lim, Young Jin |
AuthorAffiliation | 2 Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea 1 Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea |
AuthorAffiliation_xml | – name: 2 Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea – name: 1 Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea |
Author_xml | – sequence: 1 givenname: Hyuk Jai surname: Choi fullname: Choi, Hyuk Jai organization: Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea – sequence: 2 givenname: Seok Keun surname: Choi fullname: Choi, Seok Keun – sequence: 3 givenname: Young Jin surname: Lim fullname: Lim, Young Jin |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23346325$$D View this record in MEDLINE/PubMed https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001738836$$DAccess content in National Research Foundation of Korea (NRF) |
BookMark | eNpVkU1r3DAQhkVJaTZp_0APRcde7Ojb8qUQQj8CgUJIz2KslTbK2tJWsgP599XuNml6Gph5n5nhfc_QSUzRIfSRkpZzQS4etrG0jFDWStaqVnLxBq2o7HXT6U6doBUjRDa8o_QUnZXyQIjiRMt36JRVXnEmV2i-hXVIZcmbYGHEs7P3MfxeXMEQ19iOIR76aZltmmo3ebyBaQK8jcE7nJ9pl5-wTxkPGUIss5sw5NnlkB5dTEvBE4x1PMEcUizv0VsPY3Ef_tZz9Ovb17urH83Nz-_XV5c3jRVczo32nWKdpJ5TGDx0pO-9BLemfBDUSsu87mCgeuiEAqa10Fq5ngyCCymZlvwcfT7ujdmbrQ0mQTjUTTLbbC5v765NtUIpXaVfjtLdMkxubV2cM4xml8ME-ekA_j-J4b6ueTRcSiIY_Xdrl9Pev9lMoVg3jhBdNcBQphkRQvW8StlRanMqJTv_coYSs0_W7JM1-2SNZEaZmmyFPr1-8AV5jpL_AZNqpTY |
CitedBy_id | crossref_primary_10_2176_nmc_oa_2013_0090 crossref_primary_10_1097_MD_0000000000026203 crossref_primary_10_1177_1591019917711679 crossref_primary_10_1227_neu_0000000000002278 crossref_primary_10_1016_j_wneu_2016_08_051 crossref_primary_10_1016_j_jngse_2018_04_032 crossref_primary_10_1586_14737175_2015_1079129 crossref_primary_10_1016_j_wneu_2019_01_166 crossref_primary_10_1007_s10143_023_02059_4 crossref_primary_10_1007_s00701_014_2269_4 crossref_primary_10_1016_j_wneu_2018_08_099 crossref_primary_10_1007_s00062_016_0514_3 crossref_primary_10_1016_j_jocn_2019_03_009 crossref_primary_10_1097_MAO_0000000000001401 |
Cites_doi | 10.3171/jns.1992.77.1.0001 10.3171/jns.1998.88.2.0285 10.3171/jns.2000.93.supplement_3.0102 10.1227/01.NEU.0000156547.24603.EE 10.1161/01.STR.0000043674.99741.9B 10.3171/jns.1986.64.1.0001 10.1016/S0360-3016(97)00718-9 10.1161/01.STR.0000014582.03429.F7 10.1161/01.STR.29.5.931 10.3171/jns.1986.64.6.0857 10.3171/jns.1990.73.3.0387 10.1016/S0140-6736(97)05390-7 10.3171/jns.1989.70.6.0847 10.3171/jns.2004.100.3.0407 10.3171/jns.1995.83.5.0832 10.1016/S1042-3680(18)30571-0 10.3171/2011.9.JNS11176 10.1136/jnnp.68.5.563 10.1227/00006123-199404000-00029 10.3171/jns.1996.85.1.0029 10.3171/jns.1993.79.5.0647 10.3171/jns.1986.64.6.0849 10.3340/jkns.2009.46.4.378 10.1016/0090-3019(92)90059-V 10.1227/00006123-199507000-00004 10.3171/jns.1991.75.4.0512 10.1016/0360-3016(92)90937-D 10.3171/jns.1966.25.4.0467 |
ContentType | Journal Article |
Copyright | Copyright © 2012 The Korean Neurosurgical Society 2012 |
Copyright_xml | – notice: Copyright © 2012 The Korean Neurosurgical Society 2012 |
DBID | NPM AAYXX CITATION 7X8 5PM ACYCR |
DOI | 10.3340/jkns.2012.52.6.534 |
DatabaseName | PubMed CrossRef MEDLINE - Academic PubMed Central (Full Participant titles) Korean Citation Index (Open Access) |
DatabaseTitle | PubMed CrossRef MEDLINE - Academic |
DatabaseTitleList | PubMed MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
EISSN | 1598-7876 |
EndPage | 540 |
ExternalDocumentID | oai_kci_go_kr_ARTI_233668 10_3340_jkns_2012_52_6_534 23346325 |
Genre | Journal Article |
GroupedDBID | --- .UV 29K 2WC 5-W 53G 5GY 8JR 8XY 9ZL ABDBF AENEX ALMA_UNASSIGNED_HOLDINGS CS3 D-I DIK E3Z EBD EF. F5P FRP GROUPED_DOAJ HYE KVFHK NPM OK1 RPM W2D AAYXX CITATION 7X8 5PM ACYCR |
ID | FETCH-LOGICAL-c435t-8f762751f31abfa7099f5aed13b41c5c2f87ab18b746a2884886e90b434552853 |
IEDL.DBID | RPM |
ISSN | 2005-3711 |
IngestDate | Tue Nov 21 21:34:31 EST 2023 Fri Sep 01 02:37:18 EDT 2023 Fri Aug 16 01:23:47 EDT 2024 Fri Aug 23 00:57:10 EDT 2024 Sat Sep 28 07:52:46 EDT 2024 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 6 |
Keywords | Gamma knife radiosurgery Arteriovenous malformation Brainstem |
Language | English |
License | This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c435t-8f762751f31abfa7099f5aed13b41c5c2f87ab18b746a2884886e90b434552853 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 G704-001031.2012.52.6.014 |
OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550421/ |
PMID | 23346325 |
PQID | 1282044693 |
PQPubID | 23479 |
PageCount | 7 |
ParticipantIDs | nrf_kci_oai_kci_go_kr_ARTI_233668 pubmedcentral_primary_oai_pubmedcentral_nih_gov_3550421 proquest_miscellaneous_1282044693 crossref_primary_10_3340_jkns_2012_52_6_534 pubmed_primary_23346325 |
PublicationCentury | 2000 |
PublicationDate | 2012-12-01 |
PublicationDateYYYYMMDD | 2012-12-01 |
PublicationDate_xml | – month: 12 year: 2012 text: 2012-12-01 day: 01 |
PublicationDecade | 2010 |
PublicationPlace | Korea (South) |
PublicationPlace_xml | – name: Korea (South) |
PublicationTitle | Journal of Korean Neurosurgical Society |
PublicationTitleAlternate | J Korean Neurosurg Soc |
PublicationYear | 2012 |
Publisher | The Korean Neurosurgical Society 대한신경외과학회 |
Publisher_xml | – name: The Korean Neurosurgical Society – name: 대한신경외과학회 |
References | 8008179 - Neurosurgery. 1994 Apr;34(4):748-52; discussion 752-3 7472551 - J Neurosurg. 1995 Nov;83(5):832-7 15617586 - Neurosurgery. 2005;56(1):56-63; discussion 63-4 1885968 - J Neurosurg. 1991 Oct;75(4):512-24 3484518 - J Neurosurg. 1986 Jan;64(1):1-10 10213548 - Lancet. 1997 Oct 11;350(9084):1065-8 3701436 - J Neurosurg. 1986 Jun;64(6):849-56 9452237 - J Neurosurg. 1998 Feb;88(2):285-92 9596237 - Stroke. 1998 May;29(5):931-4 22077450 - J Neurosurg. 2012 Jan;116(1):44-53 10766883 - J Neurol Neurosurg Psychiatry. 2000 May;68(5):563-70 8353445 - Neurosurg Clin N Am. 1993 Jul;4(3):469-79 8109313 - Acta Neurochir Suppl (Wien). 1993;58:92-7 8683279 - J Neurosurg. 1996 Jul;85(1):29-32 11143224 - J Neurosurg. 2000 Dec;93 Suppl 3:102-3 8587687 - Neurosurgery. 1995 Jul;37(1):29-35; discussion 35-6 9457809 - Int J Radiat Oncol Biol Phys. 1998 Jan 15;40(2):273-8 1458744 - Clin Neurosurg. 1992;39:273-91 1607950 - J Neurosurg. 1992 Jul;77(1):1-8 2715811 - J Neurosurg. 1989 Jun;70(6):847-52 3701437 - J Neurosurg. 1986 Jun;64(6):857-64 2384776 - J Neurosurg. 1990 Sep;73(3):387-91 8410242 - J Neurosurg. 1993 Nov;79(5):647-52 7928482 - Int J Radiat Oncol Biol Phys. 1994 Oct 15;30(3):521-9 19893730 - J Korean Neurosurg Soc. 2009 Oct;46(4):378-84 15035275 - J Neurosurg. 2004 Mar;100(3):407-13 12468772 - Stroke. 2002 Dec;33(12):2794-800 11935037 - Stroke. 2002 Apr;33(4):920-4 1727077 - Surg Neurol. 1992 Jan;37(1):15-21 5925721 - J Neurosurg. 1966 Oct;25(4):467-90 Brown (10.3340/jkns.2012.52.6.534_ref5) 1996; 85 Engenhart (10.3340/jkns.2012.52.6.534_ref9) 1994; 30 Lee (10.3340/jkns.2012.52.6.534_ref17) 2009; 46 Sasaki (10.3340/jkns.2012.52.6.534_ref24) 1998; 88 Duma (10.3340/jkns.2012.52.6.534_ref8) 1993; 58 Kondziolka (10.3340/jkns.2012.52.6.534_ref14) 1993; 4 Steiner (10.3340/jkns.2012.52.6.534_ref27) 1992; 77 Alexander (10.3340/jkns.2012.52.6.534_ref1) 1992; 39 ApSimon (10.3340/jkns.2012.52.6.534_ref3) 2002; 33 Kano (10.3340/jkns.2012.52.6.534_ref13) 2012; 116 Drake (10.3340/jkns.2012.52.6.534_ref7) 1986; 64 Yamamoto (10.3340/jkns.2012.52.6.534_ref30) 1995; 83 Hosoda (10.3340/jkns.2012.52.6.534_ref12) 1994; 34 Batjer (10.3340/jkns.2012.52.6.534_ref4) 1986; 64 Solomon (10.3340/jkns.2012.52.6.534_ref25) 1986; 64 Steiner (10.3340/jkns.2012.52.6.534_ref28) 1993; 79 Lawton (10.3340/jkns.2012.52.6.534_ref16) 1995; 37 Lunsford (10.3340/jkns.2012.52.6.534_ref18) 1991; 75 Ondra (10.3340/jkns.2012.52.6.534_ref22) 1990; 73 Massager (10.3340/jkns.2012.52.6.534_ref20) 2000; 93 Maruyama (10.3340/jkns.2012.52.6.534_ref19) 2004; 100 Andrade-Souza (10.3340/jkns.2012.52.6.534_ref2) 2005; 56 Flickinger (10.3340/jkns.2012.52.6.534_ref10) 1998; 40 Chyatte (10.3340/jkns.2012.52.6.534_ref6) 1989; 70 Kurita (10.3340/jkns.2012.52.6.534_ref15) 2000; 68 Yamamoto (10.3340/jkns.2012.52.6.534_ref29) 1992; 37 Perret (10.3340/jkns.2012.52.6.534_ref23) 1966; 25 Hartmann (10.3340/jkns.2012.52.6.534_ref11) 1998; 29 Mast (10.3340/jkns.2012.52.6.534_ref21) 1997; 350 Stefani (10.3340/jkns.2012.52.6.534_ref26) 2002; 33 |
References_xml | – volume: 77 start-page: 1 year: 1992 ident: 10.3340/jkns.2012.52.6.534_ref27 publication-title: J Neurosurg doi: 10.3171/jns.1992.77.1.0001 contributor: fullname: Steiner – volume: 88 start-page: 285 year: 1998 ident: 10.3340/jkns.2012.52.6.534_ref24 publication-title: J Neurosurg doi: 10.3171/jns.1998.88.2.0285 contributor: fullname: Sasaki – volume: 39 start-page: 273 year: 1992 ident: 10.3340/jkns.2012.52.6.534_ref1 publication-title: Clin Neurosurg contributor: fullname: Alexander – volume: 93 start-page: 102 issue: Suppl 3 year: 2000 ident: 10.3340/jkns.2012.52.6.534_ref20 publication-title: J Neurosurg doi: 10.3171/jns.2000.93.supplement_3.0102 contributor: fullname: Massager – volume: 56 start-page: 56 year: 2005 ident: 10.3340/jkns.2012.52.6.534_ref2 publication-title: Neurosurgery doi: 10.1227/01.NEU.0000156547.24603.EE contributor: fullname: Andrade-Souza – volume: 58 start-page: 92 year: 1993 ident: 10.3340/jkns.2012.52.6.534_ref8 publication-title: Acta Neurochir Suppl (Wien) contributor: fullname: Duma – volume: 33 start-page: 2794 year: 2002 ident: 10.3340/jkns.2012.52.6.534_ref3 publication-title: Stroke doi: 10.1161/01.STR.0000043674.99741.9B contributor: fullname: ApSimon – volume: 64 start-page: 1 year: 1986 ident: 10.3340/jkns.2012.52.6.534_ref7 publication-title: J Neurosurg doi: 10.3171/jns.1986.64.1.0001 contributor: fullname: Drake – volume: 40 start-page: 273 year: 1998 ident: 10.3340/jkns.2012.52.6.534_ref10 publication-title: Int J Radiat Oncol Biol Phys doi: 10.1016/S0360-3016(97)00718-9 contributor: fullname: Flickinger – volume: 33 start-page: 920 year: 2002 ident: 10.3340/jkns.2012.52.6.534_ref26 publication-title: Stroke doi: 10.1161/01.STR.0000014582.03429.F7 contributor: fullname: Stefani – volume: 29 start-page: 931 year: 1998 ident: 10.3340/jkns.2012.52.6.534_ref11 publication-title: Stroke doi: 10.1161/01.STR.29.5.931 contributor: fullname: Hartmann – volume: 64 start-page: 857 year: 1986 ident: 10.3340/jkns.2012.52.6.534_ref25 publication-title: J Neurosurg doi: 10.3171/jns.1986.64.6.0857 contributor: fullname: Solomon – volume: 73 start-page: 387 year: 1990 ident: 10.3340/jkns.2012.52.6.534_ref22 publication-title: J Neurosurg doi: 10.3171/jns.1990.73.3.0387 contributor: fullname: Ondra – volume: 350 start-page: 1065 year: 1997 ident: 10.3340/jkns.2012.52.6.534_ref21 publication-title: Lancet doi: 10.1016/S0140-6736(97)05390-7 contributor: fullname: Mast – volume: 70 start-page: 847 year: 1989 ident: 10.3340/jkns.2012.52.6.534_ref6 publication-title: J Neurosurg doi: 10.3171/jns.1989.70.6.0847 contributor: fullname: Chyatte – volume: 100 start-page: 407 year: 2004 ident: 10.3340/jkns.2012.52.6.534_ref19 publication-title: J Neurosurg doi: 10.3171/jns.2004.100.3.0407 contributor: fullname: Maruyama – volume: 83 start-page: 832 year: 1995 ident: 10.3340/jkns.2012.52.6.534_ref30 publication-title: J Neurosurg doi: 10.3171/jns.1995.83.5.0832 contributor: fullname: Yamamoto – volume: 4 start-page: 469 year: 1993 ident: 10.3340/jkns.2012.52.6.534_ref14 publication-title: Neurosurg Clin N Am doi: 10.1016/S1042-3680(18)30571-0 contributor: fullname: Kondziolka – volume: 116 start-page: 44 year: 2012 ident: 10.3340/jkns.2012.52.6.534_ref13 publication-title: J Neurosurg doi: 10.3171/2011.9.JNS11176 contributor: fullname: Kano – volume: 68 start-page: 563 year: 2000 ident: 10.3340/jkns.2012.52.6.534_ref15 publication-title: J Neurol Neurosurg Psychiatry doi: 10.1136/jnnp.68.5.563 contributor: fullname: Kurita – volume: 34 start-page: 748 year: 1994 ident: 10.3340/jkns.2012.52.6.534_ref12 publication-title: Neurosurgery doi: 10.1227/00006123-199404000-00029 contributor: fullname: Hosoda – volume: 85 start-page: 29 year: 1996 ident: 10.3340/jkns.2012.52.6.534_ref5 publication-title: J Neurosurg doi: 10.3171/jns.1996.85.1.0029 contributor: fullname: Brown – volume: 79 start-page: 647 year: 1993 ident: 10.3340/jkns.2012.52.6.534_ref28 publication-title: J Neurosurg doi: 10.3171/jns.1993.79.5.0647 contributor: fullname: Steiner – volume: 64 start-page: 849 year: 1986 ident: 10.3340/jkns.2012.52.6.534_ref4 publication-title: J Neurosurg doi: 10.3171/jns.1986.64.6.0849 contributor: fullname: Batjer – volume: 46 start-page: 378 year: 2009 ident: 10.3340/jkns.2012.52.6.534_ref17 publication-title: J Korean Neurosurg Soc doi: 10.3340/jkns.2009.46.4.378 contributor: fullname: Lee – volume: 37 start-page: 15 year: 1992 ident: 10.3340/jkns.2012.52.6.534_ref29 publication-title: Surg Neurol doi: 10.1016/0090-3019(92)90059-V contributor: fullname: Yamamoto – volume: 37 start-page: 29 year: 1995 ident: 10.3340/jkns.2012.52.6.534_ref16 publication-title: Neurosurgery doi: 10.1227/00006123-199507000-00004 contributor: fullname: Lawton – volume: 75 start-page: 512 year: 1991 ident: 10.3340/jkns.2012.52.6.534_ref18 publication-title: J Neurosurg doi: 10.3171/jns.1991.75.4.0512 contributor: fullname: Lunsford – volume: 30 start-page: 521 year: 1994 ident: 10.3340/jkns.2012.52.6.534_ref9 publication-title: Int J Radiat Oncol Biol Phys doi: 10.1016/0360-3016(92)90937-D contributor: fullname: Engenhart – volume: 25 start-page: 467 year: 1966 ident: 10.3340/jkns.2012.52.6.534_ref23 publication-title: J Neurosurg doi: 10.3171/jns.1966.25.4.0467 contributor: fullname: Perret |
SSID | ssj0063085 |
Score | 2.0215168 |
Snippet | Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures.... OBJECTIVEBrainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological... Objective : Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological... |
SourceID | nrf pubmedcentral proquest crossref pubmed |
SourceType | Open Website Open Access Repository Aggregation Database Index Database |
StartPage | 534 |
SubjectTerms | Clinical 신경외과학 |
Title | Radiosurgical techniques and clinical outcomes of gamma knife radiosurgery for brainstem arteriovenous malformations |
URI | https://www.ncbi.nlm.nih.gov/pubmed/23346325 https://search.proquest.com/docview/1282044693 https://pubmed.ncbi.nlm.nih.gov/PMC3550421 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001738836 |
Volume | 52 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
ispartofPNX | 대한신경외과학회지, 2012, 52(6), , pp.534-540 |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lj9MwELa2e-KCQLzKY2UkbihpbMd2eoQVywIqILQr7c1yHBtKW2eVpkj8e2acptpFnDhF8kOO_Y09M_L4G0JeSce4q2yROebBQZFCZbUXOtM8yNBYPXeJjmHxWZ1flh-v5NURkeNbmBS07-plHtebPC5_pNjK642bjXFis6-LU9CRIGtsNiETLcToog_HrxJFysOZKDaFZmx4KSNEWcx-riIydDOeS56rXArMysOhSglMlX1DMU1iF_5lc_4dOnlDF53dI3f3RiR9M_zsfXLk4wPSf7PNst3uunSW0YuRnHVLbWzonv9zTb_sehAyKG0DfW83G0s_YXgLPfT23W8Klix9i8kjkOYZxwE5bX8lOle6sOvDi8ftQ3J59u7i9Dzb51TIHBhGfVYFjbzELAhm62A1GIhBWt8wUZfMScdDpW3NqlqXyvKqgv2t_LyoS1FKyUG3PyLHsY3-CaHaWe8Zs0x48PFYUTlwtIMKbA57PDTllLweF9RcD9QZBlwORMIgEgaRMJIbZQCJKXkJa25WbmmQ8Rq_31uz6gzY9R8MgKRUBW1GRAzsArzasNHD1A1oWY5X03MxJY8HhA5jjgBPib6F3aEBjne7BgQvMW3vBe3pf_d8Ru7gLIf4l-fkuO92_gVYMX19krz_kyS7fwB7ePM5 |
link.rule.ids | 230,315,733,786,790,870,891,27957,27958,53827,53829 |
linkProvider | National Library of Medicine |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3Nb9MwFLe2cYDLAPHV8WUkbihpbMd2eoSJ0bF1INSh3SzbsaG0daY0RYK_nuekqbaJC5wixbYs6_c-5effQ-g1t4TaQmeJJQ4SFM5EYhyTiaSe-1LLkW3pGCZnYnyef7zgFzuI929h2qJ9a2ZpWCzTMPve1lZeLu2wrxMbfp4cgo8EWSPDXXQL9JXKPknvDLBgWduJsyXZZJKQ7q0MY3k2_DEPkaOb0JTTVKScxb48FIYEi82yr7im3VD7v0WdN4snr3ijo7voa3-Orghlnq4bk9rfNyge__mg99D-Jj7Fb7vh-2jHhQeo-aLLWbVa162ZxNOe93WFdSjxhlp0gT-tG5Bf-Ft5_EEvlxqfxMoZvF3t6l8YgmT8LvaliAzScR9QgepnyxSLJ3qxfUy5eojOj95PD8fJpl1DYiHmapLCy0h5TDwj2ngtIfb0XLuSMJMTyy31hdSGFEbmQtOiANMh3CgzOcs5pxA2PEJ7oQruCcLSaucI0YQ5SB9JVljI4b3wZATmw5f5AL3pkVKXHSuHgmwmQqwixCpCrDhVQgHEA_QKwFRzO1ORTDt-v1VqXitIGY4VoC9EAXN6qBUoWLw10cHB0RU4cBpvvUdsgB530G_37CVngOQ1odhOiPtdHwGoWxLvDbQH_73yJbo9nk5O1enx2clTdCeeuCuzeYb2mnrtnkOw1JgXrWr8AbO1FD8 |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1bb9MwFLbYkBAvXMStXI3EG8rFdmwnjzAoG6NjQps08WLZjg2lbVKlKRL8eo6TpuomnvYUKbZlWd-5ysffQegNt4TaXKeRJQ4SFM5EZByTkaSe-1LLwnZ0DJMTcXiefb7gFzutvrqifWumcTVfxNX0Z1dbuVzYZKgTS04nB-AjQdZIsix9sodugs7SYkjUeyMsWNp14-yINpkkpH8vw1iWJr9mVeDpJjTmNBYxZ6E3D4UhwULD7B33tFc1_n-R59UCyh2PNL6Lvg9n6QtRZvG6NbH9e4Xm8VqHvYfubOJU_K6fch_dcNUD1H7T5bRerZvOXOKzgf91hXVV4g3F6Bx_Xbcgx_C39viTXiw0Pg4VNHi72jV_MATL-H3oTxGYpMM-oAr1744xFk_0fPuocvUQnY8_nh0cRpu2DZGF2KuNci8D9THxjGjjtYQY1HPtSsJMRiy31OdSG5IbmQlN8xxMiHBFajKWcU4hfHiE9qu6ck8QllY7R4gmzEEaSdLcQi7vhScFmBFfZiP0dkBLLXt2DgVZTYBZBZhVgFlxqoQCmEfoNQCqZnaqAql2-P6o1axRkDocKZAAIXKYM8CtQNHC7YmuHBxdgSOn4fa7YCP0uId_u-cgPSMkLwnGdkLY7_IIwN2ReW_gfXrtla_QrdMPY_Xl6OT4GbodDtxX2zxH-22zdi8gZmrNy047_gFSUBa_ |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Radiosurgical+techniques+and+clinical+outcomes+of+gamma+knife+radiosurgery+for+brainstem+arteriovenous+malformations&rft.jtitle=Journal+of+Korean+Neurosurgical+Society&rft.au=Choi%2C+Hyuk+Jai&rft.au=Choi%2C+Seok+Keun&rft.au=Lim%2C+Young+Jin&rft.date=2012-12-01&rft.issn=2005-3711&rft.volume=52&rft.issue=6&rft.spage=534&rft_id=info:doi/10.3340%2Fjkns.2012.52.6.534&rft_id=info%3Apmid%2F23346325&rft.externalDocID=23346325 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2005-3711&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2005-3711&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2005-3711&client=summon |