Dale Ding1, Robert M Starke1, Hideyuki Kano2, John Y K Lee3, David Mathieu4, John Pierce3, Paul Huang5, Symeon Missios6, Caleb Feliciano7, Rafael Rodriguez-Mercado7, Luis Almodovar7, Inga S Grills8, Danilo Silva6, Mahmoud Abbassy6, Douglas Kondziolka5, Gene H Barnett6, L Dade Lunsford2, Jason P Sheehan1. 1. Department of Neurosurgery, Uni-versity of Virginia, Charlottesville, Virginia. 2. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pensylvania. 3. Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania. 4. Division of Neurosurgery, University of Sher-brooke, Centre de recherché du CHUS, Sherbrooke, Quebec, Canada. 5. Department of Neurosurgery, New York University Langone Medical Center, New York, New York. 6. Department of Neurosurgery, Cleveland Clinic Foun-dation, Cleveland, Ohio. 7. Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico. 8. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
Abstract
BACKGROUND: The role of intervention in the management of unruptured brain arteriovenous malformations (AVM) is controversial. OBJECTIVE: To analyze in a multicenter, retrospective cohort study, the outcomes following radiosurgery for unruptured AVMs and determine predictive factors. METHODS: We evaluated and pooled AVM radiosurgery data from 8 institutions participating in the International Gamma Knife Research Foundation. Patients with unruptured AVMs and ≥12 mo of follow-up were included in the study cohort. Favorable outcome was defined as AVM obliteration, no postradiosurgical hemorrhage, and no permanently symptomatic radiation-induced changes. RESULTS: The unruptured AVM cohort comprised 938 patients with a median age of 35 yr. The median nidus volume was 2.4 cm 3 , 71% of AVMs were located in eloquent brain areas, and the Spetzler-Martin grade was III or higher in 57%. The median radiosurgical margin dose was 21 Gy and follow-up was 71 mo. AVM obliteration was achieved in 65%. The annual postradiosurgery hemorrhage rate was 1.4%. Symptomatic and permanent radiation-induced changes occurred in 9% and 3%, respectively. Favorable outcome was achieved in 61%. In the multivariate logistic regression analysis, smaller AVM maximum diameter ( P = .001), the absence of AVM-associated arterial aneurysms ( P = .001), and higher margin dose ( P = .002) were found to be independent predictors of a favorable outcome. A margin dose ≥ 20 Gy yielded a significantly higher rate of favorable outcome (70% vs 36%; P < .001). CONCLUSION: Radiosurgery affords an acceptable risk to benefit profile for patients harboring unruptured AVMs. These findings justify further prospective studies comparing radiosurgical intervention to conservative management for unruptured AVMs.
BACKGROUND: The role of intervention in the management of unruptured brain arteriovenous malformations (AVM) is controversial. OBJECTIVE: To analyze in a multicenter, retrospective cohort study, the outcomes following radiosurgery for unruptured AVMs and determine predictive factors. METHODS: We evaluated and pooled AVM radiosurgery data from 8 institutions participating in the International Gamma Knife Research Foundation. Patients with unruptured AVMs and ≥12 mo of follow-up were included in the study cohort. Favorable outcome was defined as AVM obliteration, no postradiosurgical hemorrhage, and no permanently symptomatic radiation-induced changes. RESULTS: The unruptured AVM cohort comprised 938 patients with a median age of 35 yr. The median nidus volume was 2.4 cm 3 , 71% of AVMs were located in eloquent brain areas, and the Spetzler-Martin grade was III or higher in 57%. The median radiosurgical margin dose was 21 Gy and follow-up was 71 mo. AVM obliteration was achieved in 65%. The annual postradiosurgery hemorrhage rate was 1.4%. Symptomatic and permanent radiation-induced changes occurred in 9% and 3%, respectively. Favorable outcome was achieved in 61%. In the multivariate logistic regression analysis, smaller AVM maximum diameter ( P = .001), the absence of AVM-associated arterial aneurysms ( P = .001), and higher margin dose ( P = .002) were found to be independent predictors of a favorable outcome. A margin dose ≥ 20 Gy yielded a significantly higher rate of favorable outcome (70% vs 36%; P < .001). CONCLUSION: Radiosurgery affords an acceptable risk to benefit profile for patients harboring unruptured AVMs. These findings justify further prospective studies comparing radiosurgical intervention to conservative management for unruptured AVMs.
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: Ali Alkhabiry; Othman T Almutairi; Turki Elarjani; Mohammed Bafaquh; Hossam Alassaf; Abdulrahman Y Alturki Journal: Surg Neurol Int Date: 2020-12-29
Authors: Ryan Kelly; Anthony Conte; M Nathan Nair; Jean-Marc Voyadzis; Amjad Anaizi; Sean Collins; Christopher Kalhorn; Andrew Stemer; Jeffery Mai; Rocco Armonda; Jonathan Lischalk; Frank Berkowitz; Vikram Nayar; Kevin McGrail; Brian Timothy Collins Journal: Front Oncol Date: 2020-11-30 Impact factor: 6.244