%0 Journal Article
%T Hypofractionated Stereotactic Radiosurgery in a Large Bilateral Thalamic and Basal Ganglia Arteriovenous Malformation
%A Janet Lee
%A Tomoko Tanaka
%A Steven Westgate
%A Ashish Nanda
%A Marshall Cress
%A N. Scott Litofsky
%J Case Reports in Neurological Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/631028
%X Purpose. Arteriovenous malformations (AVMs) in the basal ganglia and thalamus have a more aggressive natural history with a higher morbidity and mortality than AVMs in other locations. Optimal treatment¡ªcomplete obliteration without new neurological deficits¡ªis often challenging. We present a patient with a large bilateral basal ganglia and thalamic AVM successfully treated with hypofractionated stereotactic radiosurgery (HFSRS) with intensity modulated radiotherapy (IMRT). Methods. The patient was treated with hypofractionated stereotactic radiosurgery to 30£¿Gy at margin in 5 fractions of 9 static fields with a minimultileaf collimator and intensity modulated radiotherapy. Results. At 10 months following treatment, digital subtraction angiography showed complete obliteration of the AVM. Conclusions. Large bilateral thalamic and basal ganglia AVMs can be successfully treated with complete obliteration by HFSRS with IMRT with relatively limited toxicity. Appropriate caution is recommended. 1. Introduction Arteriovenous malformations (AVMs) in the basal ganglia and thalamus comprise a small percentage of all AVMs [1¨C4]. These deep AVMs have a more aggressive natural history with a higher morbidity and mortality than AVMs in other locations [5]. Bilateral basal ganglia and thalamic AVMs are extremely rare. The majority of patients harboring these lesions present with hemorrhage and serious neurologic sequela. Optimal treatment¡ªcomplete obliteration without new neurological deficits¡ªis often challenging. Stereotactic radiosurgery (SRS) is generally accepted as the first option in treatment [3, 5, 6]. In this report, we present a patient with a large bilateral basal ganglia and thalamic AVM successfully treated with hypofractionated stereotactic radiosurgery (HFSRS) with intensity modulated radiotherapy (IMRT). There have been no other case reports of bilateral AVMs of this size successfully treated with radiosurgery. In particular, the complete obliteration of the AVMs after HFSRS with one year of treatment is noteworthy. 2. Case Report 2.1. History and Examination A 12-year-old male presented to his primary care physician with a 3-month history of progressive gait abnormality. On physical examination, he had a subtle left facial droop and hyperreflexia in the left lower extremity. His gait was mildly ataxic with circumduction of the left leg. He was unable to heel walk on the left, and he had sidestepping with tandem gait. Toe walking was preserved. His motor and sensory exam was otherwise unremarkable. During his initial hospitalization for further
%U http://www.hindawi.com/journals/crinm/2013/631028/