Dale Ding1, Robert M Starke2, Hideyuki Kano3, David Mathieu4, Paul P Huang5, Douglas Kondziolka5, Caleb Feliciano6, Rafael Rodriguez-Mercado6, Luis Almodovar6, Inga S Grills7, Danilo Silva8, Mahmoud Abbassy8, Symeon Missios8, Gene H Barnett8, L Dade Lunsford3, Jason P Sheehan9. 1. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. 2. Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA. 3. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 4. Division of Neurosurgery, Department of Neurosurgery, University of Sherbrooke, Centre de recherché du CHUS, Sherbrooke, Quebec, Canada. 5. Department of Neurosurgery, New York University, Langone Medical Center, New York, New York, USA. 6. Section of Neurosurgery, Department of Surgery, University of Puerto Rico, San Juan, Puerto Rico, USA. 7. Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA. 8. Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 9. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jps2f@virginia.edu.
Abstract
OBJECTIVE:ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) found better short-term outcomes after conservative management compared with intervention for unruptured arteriovenous malformations (AVMs). However, because Spetzler-Martin (SM) grade I-II AVMs have the lowest treatment morbidity, sufficient follow-up of these lesions may show a long-term benefit from intervention. The aim of this multicenter, retrospective cohort study is to assess the outcomes after stereotactic radiosurgery (SRS) for ARUBA-eligible SM grade I-II AVMs. METHODS: We pooled SRS data for patients with AVM from 7 institutions and selected ARUBA-eligible SM grade I-II AVMs with ≥12 months follow-up for analysis. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes. RESULTS: The ARUBA-eligible SM grade I-II AVM cohort comprised 232 patients (mean age, 42 years). The mean nidus volume, SRS margin dose, and follow-up duration were 2.1 cm3, 22.5 Gy, and 90.5 months, respectively. The actuarial obliteration rates at 5 and 10 years were 72% and 87%, respectively; annual post-SRS hemorrhage rate was 1.0%; symptomatic and permanent radiation-induced changes occurred in 8% and 1%, respectively; and favorable outcome was achieved in 76%. Favorable outcome was significantly more likely in patients treated with a margin dose >20 Gy (83%) versus ≤20 Gy (62%; P < 0.001). Stroke or death occurred in 10% after SRS. CONCLUSIONS: For ARUBA-eligible SM grade I-II AVMs, long-term SRS outcomes compare favorably with the natural history. SRS should be considered for adult patients harboring unruptured, previously untreated low-grade AVMs with a minimum life expectancy of a decade.
RCT Entities:
OBJECTIVE:ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) found better short-term outcomes after conservative management compared with intervention for unruptured arteriovenous malformations (AVMs). However, because Spetzler-Martin (SM) grade I-II AVMs have the lowest treatment morbidity, sufficient follow-up of these lesions may show a long-term benefit from intervention. The aim of this multicenter, retrospective cohort study is to assess the outcomes after stereotactic radiosurgery (SRS) for ARUBA-eligible SM grade I-II AVMs. METHODS: We pooled SRS data for patients with AVM from 7 institutions and selected ARUBA-eligible SM grade I-II AVMs with ≥12 months follow-up for analysis. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes. RESULTS: The ARUBA-eligible SM grade I-II AVM cohort comprised 232 patients (mean age, 42 years). The mean nidus volume, SRS margin dose, and follow-up duration were 2.1 cm3, 22.5 Gy, and 90.5 months, respectively. The actuarial obliteration rates at 5 and 10 years were 72% and 87%, respectively; annual post-SRS hemorrhage rate was 1.0%; symptomatic and permanent radiation-induced changes occurred in 8% and 1%, respectively; and favorable outcome was achieved in 76%. Favorable outcome was significantly more likely in patients treated with a margin dose >20 Gy (83%) versus ≤20 Gy (62%; P < 0.001). Stroke or death occurred in 10% after SRS. CONCLUSIONS: For ARUBA-eligible SM grade I-II AVMs, long-term SRS outcomes compare favorably with the natural history. SRS should be considered for adult patients harboring unruptured, previously untreated low-grade AVMs with a minimum life expectancy of a decade.
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: Christopher S Graffeo; Arjun Sahgal; Antonio De Salles; Laura Fariselli; Marc Levivier; Lijun Ma; Ian Paddick; Jean Marie Regis; Jason Sheehan; John Suh; Shoji Yomo; Bruce E Pollock Journal: Neurosurgery Date: 2020-09-01 Impact factor: 4.654