STEREOTACTIC RADIOSURGERY AS AN OPTION THERAPY IN PATIENTS WITH HCV AND MALFORMATIONS ARTERIOVENOUS
Palavras-chave:
Hemorragia Intracraniana, Malformações Arteriovenosas, Radiocirurgia EstereotáxicaResumo
INTRODUCTION: Stereotactic radiosurgery (SRS) is a non-invasive technique that
uses externally generated ionizing radiation to inactivate specific targets in the brain or
column. It is indicated for patients with high surgical risk, such as elderly or
multiple comorbidities, in addition to allowing access to deep or critical regions. Their
main applications include treatment of cerebral and spinal metastases, neuralgia of the
trigemeths, meningiomas, schwannomas and arteriovenous malformations (MAVs).
OBJECTIVE: Analyze the relevance of SRS as a neurosurgical treatment for VAMs in patients
with hemorrhagic stroke (HVAc). METHODOLOGY: A review was integrative literature in
the databases PubMed, SciELO and LILACS, with search for articles published in the last 10
years. Original peer-reviewed studies were included, published in Portuguese, English or
Spanish, with access to the full text and addressing the association between stereotactic
radiosurgery, VAMs and HFCAs. Case reports were excluded, letters to the editor and studies
that did not directly address the theme. RESULTS: The MAVs are complex vascular lesions in
which arterial blood flows directly to the venous system by multiple fistulous communications
and without capillary bed, generating hyperflow and increased risk of rupture. This condition
is associated with the occurrence of HCVAh, especially in young adults, accounting for
approximately 25% of cases in individuals with less than 50 years. SRS acts with converging
radiation beams, causing vascular damage focal and promoting obliteration of AVM by
endothelial proliferation. Additionally, it reduces pro-angiogenic mediators such as VEGF,
TGFβ, angiopoietin-2 and growth factor basic of fibroblasts in up to three months, decreasing
the risk of further bleeding. basic of fibroblasts in up to three months, decreasing the risk of
further bleeding. CONCLUSION: Stereotactic radiosurgery is an effective, safe and minimally
invasive and with lower cost, presenting low rate of complications. Your indication is relevant
in more complex lesions or in patients with contraindications to conventional surgical
treatment.
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