Stereotactic body radiotherapy for a large arteriovenous malformation of the head and neck

Abstract

Large arteriovenous malformations (AVMs) of the head and neck present a treatment challenge. A 38-year-old woman presented with a large intraoral bleed from longstanding AVMs of the left infratemporal fossa and the right tongue, despite 10 prior surgeries and embolizations. She was treated with stereotactic body radiotherapy with a dose of 24 Gy in three weekly fractions. Four years later, she has had dramatic shrinkage of her AVM, no recurrent bleeding episodes, no further treatment required, and no significant late effects. Level of evidence: NA.

Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations

“…[13] described the development of intractable facial pain in the month following SRS which necessitated the insertion of an intrathecal pain pump [13]. Follow-up of these 4 patients treated by SRS ranged from 7 to 54 months (7,34,42, and 54 months, respectively); however, only minor AREs were reported in the form of the moderate xerostomie, mild trismus, and skin fibrosis [13]. Other risks related to such treatment strategies might be gum/tooth loss as late effects.…”

“…A complete obliteration of the AVM was documented by DSA at 34 months after the CK SRS [14]. The second case was reported by Koyfman et al [13], who published a case of left infratemporal fossa and right-sided tongue AVMs treated by stereotactic body RT (SBRT). Although two extensive surgical resections and 8 embolizations were realized, the clinical status of the patient was aggravated.…”

“…The clinical course was satisfactory. After 4.5 years of follow-up, facial symmetry was improved and the size and pulsatility of the left buccal AVM was diminished, but not fully obliterated [13].…”

“…Furthermore, from a stereotactic point of view, they are situated either outside the frame space or in mobile regions. Only two previous reports have described radiotherapy (RT) [13] and Cyberknife (CK; Accuray, Madison, WI, USA) SRS [14] as a treatment for these rare conditions.…”

Spontaneous Regression of Parapharyngeal Arteriovenous Malformation

“…2 They can be treated with trans-arterial embolization (TAE), surgery, sclerotherapy, radiotherapy, or a combination of these methods. 3 Multidisciplinary treatment is required to achieve an optimal outcome. Preoperative TAE with or without resection is considered the first line of management.…”