BACKGROUND AND PURPOSE: The purpose of this study was to define the risk of rebleeding after stereotactic radiosurgery (SRS) for hemorrhagic arteriovenous malformations with or without associated intracranial aneurysms. METHODS: Between 1987 and 2006, we performed Gamma Knife SRS on 996 patients with brain arteriovenous malformations; 407 patients had sustained an arteriovenous malformation hemorrhage. Sixty-four patients (16%) underwent prior embolization and 84 (21%) underwent prior surgical resection. The median target volume was 2.3 mL (range, 0.1-20.7 mL). The median margin dose was 20 Gy (range, 13.5-27 Gy). RESULTS: The overall rate of total obliteration defined by angiography or MRI was 56%, 77%, 80%, and 82% at 3, 4, 5, and 10 years, respectively. Before obliteration, 33 patients (8%) sustained an additional hemorrhage after SRS. The overall annual hemorrhage rate until obliteration after SRS was 1.3%. The presence of a patent aneurysm was significantly associated with an increased rehemorrhage risk after SRS (annual hemorrhage rate, 6.4%) compared with patients with a clipped or embolized aneurysm (annual hemorrhage rate, 0.8%; P=0.033). CONCLUSIONS: When an aneurysm is identified in patients with arteriovenous malformations selected for SRS, additional endovascular or surgical strategies should be considered to reduce the risk of bleeding during the latency interval.
BACKGROUND AND PURPOSE: The purpose of this study was to define the risk of rebleeding after stereotactic radiosurgery (SRS) for hemorrhagic arteriovenous malformations with or without associated intracranial aneurysms. METHODS: Between 1987 and 2006, we performed Gamma Knife SRS on 996 patients with brain arteriovenous malformations; 407 patients had sustained an arteriovenous malformation hemorrhage. Sixty-four patients (16%) underwent prior embolization and 84 (21%) underwent prior surgical resection. The median target volume was 2.3 mL (range, 0.1-20.7 mL). The median margin dose was 20 Gy (range, 13.5-27 Gy). RESULTS: The overall rate of total obliteration defined by angiography or MRI was 56%, 77%, 80%, and 82% at 3, 4, 5, and 10 years, respectively. Before obliteration, 33 patients (8%) sustained an additional hemorrhage after SRS. The overall annual hemorrhage rate until obliteration after SRS was 1.3%. The presence of a patent aneurysm was significantly associated with an increased rehemorrhage risk after SRS (annual hemorrhage rate, 6.4%) compared with patients with a clipped or embolized aneurysm (annual hemorrhage rate, 0.8%; P=0.033). CONCLUSIONS: When an aneurysm is identified in patients with arteriovenous malformations selected for SRS, additional endovascular or surgical strategies should be considered to reduce the risk of bleeding during the latency interval.
Authors: Daniel Umansky; Benjamin W Corn; Ido Strauss; Natan Shtraus; Shlomi Constantini; Vladimir Frolov; Shimon Maimon; Andrew A Kanner Journal: Childs Nerv Syst Date: 2018-06-07 Impact factor: 1.475
Authors: Yi-Chieh Hung; Nasser Mohammed; Kathryn N Kearns; Ching-Jen Chen; Robert M Starke; Hideyuki Kano; John Lee; David Mathieu; Anthony M Kaufmann; Wei Gang Wang; Inga S Grills; Christopher P Cifarelli; John Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez-Mercado; L Dade Lunsford; Jason P Sheehan Journal: Neurosurgery Date: 2020-05-01 Impact factor: 4.654
Authors: Ching-Jen Chen; Dale Ding; Cheng-Chia Lee; Kathryn N Kearns; I Jonathan Pomeraniec; Christopher P Cifarelli; David E Arsanious; Roman Liscak; Jaromir Hanuska; Brian J Williams; Mehran B Yusuf; Shiao Y Woo; Natasha Ironside; Rebecca M Burke; Ronald E Warnick; Daniel M Trifiletti; David Mathieu; Monica Mureb; Carolina Benjamin; Douglas Kondziolka; Caleb E Feliciano; Rafael Rodriguez-Mercado; Kevin M Cockroft; Scott Simon; Heath B Mackley; Samer G Zammar; Neel T Patel; Varun Padmanaban; Nathan Beatson; Anissa Saylany; John Y K Lee; Jason P Sheehan Journal: J Neurosurg Date: 2020-12-11 Impact factor: 5.408
Authors: Narlin B Beaty; Jessica K Campos; Geoffrey P Colby; Li-Mei Lin; Matthew T Bender; Risheng Xu; Alexander L Coon Journal: Interv Neurol Date: 2018-02-03