OBJECTIVE: The radiosurgical outcomes for cerebral arteriovenous malformations (AVM) with AVM-associated arterial aneurysms (AAA) are poorly understood, because many AAAs are embolized before nidal intervention. The aim of this retrospective case-control study is to determine the effect of AAAs on AVM radiosurgery outcomes. METHODS: We evaluated an institutional AVM radiosurgery database from 1989 to 2013. AAAs were classified as intranidal (type I) or prenidal (type II). The case cohort comprised AVMs with patent type I or II AAAs. The control cohort comprised AVMs without AAAs and matched 2:1 to the case cohort. RESULTS: The case cohort comprised 51 AVMs, including 23 with type I and 28 with type II AAAs. The control cohort comprised 102 AVMs without AAAs. The cumulative AVM obliteration, annual postradiosurgery hemorrhage, and radiologically evident radiation-induced changes rates were 67%, 3.3%, and 28%, respectively, for the case cohort, compared with 70%, 2.0%, and 35%, respectively, for the control cohort. The presence of an AAA was not significantly associated with obliteration (P = 0.293), postradiosurgery hemorrhage (P = 0.209), or radiation-induced changes (P = 0.323). The rates of type II AAA occlusion at 3, 5, and 10 years were 46%, 77%, and 95%, respectively. The type II AAA occlusion rate was significantly higher in obliterated AVMs (P = 0.002). CONCLUSIONS: Patent intranidal or prenidal AAAs do not significantly affect AVM radiosurgical outcomes. Occlusion of distal prenidal AAAs commonly occurs after radiosurgery. These findings may support a more conservative stance for embolization before radiosurgery for AVMs with AAAs.
OBJECTIVE: The radiosurgical outcomes for cerebral arteriovenous malformations (AVM) with AVM-associated arterial aneurysms (AAA) are poorly understood, because many AAAs are embolized before nidal intervention. The aim of this retrospective case-control study is to determine the effect of AAAs on AVM radiosurgery outcomes. METHODS: We evaluated an institutional AVM radiosurgery database from 1989 to 2013. AAAs were classified as intranidal (type I) or prenidal (type II). The case cohort comprised AVMs with patent type I or II AAAs. The control cohort comprised AVMs without AAAs and matched 2:1 to the case cohort. RESULTS: The case cohort comprised 51 AVMs, including 23 with type I and 28 with type II AAAs. The control cohort comprised 102 AVMs without AAAs. The cumulative AVM obliteration, annual postradiosurgery hemorrhage, and radiologically evident radiation-induced changes rates were 67%, 3.3%, and 28%, respectively, for the case cohort, compared with 70%, 2.0%, and 35%, respectively, for the control cohort. The presence of an AAA was not significantly associated with obliteration (P = 0.293), postradiosurgery hemorrhage (P = 0.209), or radiation-induced changes (P = 0.323). The rates of type II AAA occlusion at 3, 5, and 10 years were 46%, 77%, and 95%, respectively. The type II AAA occlusion rate was significantly higher in obliterated AVMs (P = 0.002). CONCLUSIONS: Patent intranidal or prenidal AAAs do not significantly affect AVM radiosurgical outcomes. Occlusion of distal prenidal AAAs commonly occurs after radiosurgery. These findings may support a more conservative stance for embolization before radiosurgery for AVMs with AAAs.
Authors: Jordan R Conger; Dale Ding; Daniel M Raper; Robert M Starke; Christopher R Durst; Kenneth C Liu; Mary E Jensen; Avery J Evans Journal: J Cerebrovasc Endovasc Neurosurg Date: 2016-06-30
Authors: Dale Ding; Thomas J Buell; Daniel M Raper; Ching-Jen Chen; Panagiotis Mastorakos; Kenneth C Liu; Dennis G Vollmer Journal: Cureus Date: 2018-02-07
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