PURPOSE: To evaluate repeat radiosurgery (RS2) for @entity7026 (AVMs) after failure of initial radiosurgery ( @entity62890 ). METHODS AND MATERIALS: Between 1986 and 2000, 41 @entity1 underwent RS2. Nine @entity1 were not assessable: seven had insufficient follow-up (RS2 in 1999 and 2000) and two had no recent control angiography data. Thus, 32 (78%) of 41 @entity1 were assessed. Most lesions (29 [90%] of 32) were supratentorial: 22 (69%) on the left, 8 (25%) on the right, and 2 on the midline (6%). The @entity1 had Spetzler-Martin Grade 1-5 (median Grade 3). The symptoms before @entity62890 included @entity548 in 20 (63%), @entity302 in 10 (31%), progressive @entity51 in 2 (6%), and @entity10 in 6 (19%). Five @entity1 had two or more symptoms. Twenty-two @entity1 (69%) had received other treatment before @entity62890 , including neurosurgery in 3 @entity1 (9%) and one to six embolizations in 19 @entity1 . At @entity62890 , the median largest nidus dimension was 2.7 cm (range 0.8-5). The median volume was 2.7 cm(3) (range 1.2-9.9). The median time from @entity62890 to RS2 was 52 months (range 12-126). Between @entity62890 and RS2, 7 (22%) of 32 @entity1 experienced @entity548 . The same irradiation technique was used for @entity62890 and RS2, except for 2 @entity1 who underwent RS2 at another institution. Circular 15-MV X-ray minibeams (range 6-20 mm) and coronal arcs were used. @entity62890 was monoisocentric in 75% of cases and multiisocentric in 25%. At RS2, the median largest nidus dimension was 3 cm (range 1.4-5). The median volume was 4.2 cm(3) (range 0.8-13.4). RS2 was monocentric in 72% of cases and multiisocentric in 28%. After RS2, the median follow-up was 19.5 months (range 0-79; mean 25.3). RESULTS: After RS2, the obliteration rate was 59.3% (19 of 32). The median time to arteriographic obliteration was 21 months (range 12-96). The survival rate was 97% (31 of 32). Five of the 13 @entity1 with a nonobliterated nidus experienced complications; 3 had @entity548 (9%) and 2 without prior @entity51 developed partially regressive @entity51 . One @entity1 with a previously existing deficit developed an additional new partially regressive @entity51 after an episode of @entity548 . Thus, 3 (9%) of 32 @entity1 had @entity16 . Moderate-grade parenchymal changes at MRI increased after RS2 (88.2% vs. 57.7% after @entity62890 ; p = 0.10, not significant). However, @entity39 -like changes did not significantly increase. After @entity62890 failure, salvage may be attempted by embolization, neurosurgery, or RS2. RS2 should be considered after the second successive annual angiogram if reduction of the nidus is <25%. CONCLUSION: The results after RS2 are encouraging. A multidisciplinary approach is mandatory to reduce the initial failure rate and to choose the modality and timing of salvage treatment.

Repeat linear accelerator radiosurgery for XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity7026 :: ('MESH:D002538', 'Disease') :: ['cerebral arteriovenous malformations'] @entity62890 :: ('6247', 'Gene') :: ['RS1'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhage', 'bleeding'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurologic complications'] @entity51 :: ('MESH:D009461', 'Disease') :: ['neurologic deficit', 'neurologic deficits'] @entity302 :: ('MESH:D004827', 'Disease') :: ['epilepsy'] @entity10 :: ('MESH:D006261', 'Disease') :: ['headaches']
@entity7026 :: (MESH:D002538,Disease) :: ['cerebral arteriovenous malformations']
