Or Cohen-Inbar1,2, Robert M Starke1, Cheng-Chia Lee3, Hideyuki Kano4, Paul Huang5, Douglas Kondziolka5, Inga S Grills6, Danilo Silva7, Mohmoud Abbassy7, Symeon Missios7, Gene H Barnett7, L Dade Lunsford4, Jason P Sheehan1. 1. Department of Neurosurgery and Gamma-Knife center, University of Virginia, Charlottesville, Virginia. 2. Department of Neurosurgery, Rambam Health Care Center Haifa Israel, Technion Israel Institute of Technology, Haifa, Israel. 3. Department of Neurological Surgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan. 4. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania. 5. Department of Neurosurgery, New York University Langone Medical Center, New York, New York. 6. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan. 7. Rose-Ella Burkhardt Brain Tumor and Neuro-oncology center, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: The management of brainstem arteriovenous malformations (bAVMs) is a formidable challenge. bAVMs harbor higher morbidity and mortality compared to other locations. OBJECTIVE: To review the outcomes following stereotactic radiosurgery (SRS) of bAVMs in a multicenter study. METHODS: Six medical centers contributed data from 205 patients through the International Gamma Knife Research Foundation. Median age was 32 yr (6-81). Median nidus volume was 1.4 mL (0.1-69 mL). Favorable outcome (FO) was defined as AVM obliteration and no post-treatment hemorrhage or permanent symptomatic radiation-induced complications. RESULTS: Overall obliteration was reported in 65.4% (n = 134) at a mean follow-up of 69 mo. Obliteration was angiographically proven in 53.2% (n = 109) and on MRA in 12.2% (n = 25). Actuarial rate of obliteration at 2, 3, 5, 7, and 10 yr after SRS was 24.5%, 43.3%, 62.3%, 73%, and 81.8% respectively. Patients treated with a margin dose >20 Gy were more likely to achieve obliteration (P = .001). Obliteration occurred earlier in patients who received a higher prescribed margin dose (P = .05) and maximum dose (P = .041). Post-SRS hemorrhage occurred in 8.8% (n = 18). Annual postgamma knife latency period hemorrhage was 1.5%. Radiation-induced complications were radiologically evident in 35.6% (n = 73), symptomatic in 14.6% (n = 30), and permanent in 14.6% (n = 30, which included long-tract signs and new cranial nerve deficits). FO was achieved in 64.4% (n = 132). Predictors of an FO were a higher Virginia radiosurgery AVM scale score (P = .003), prior hemorrhage (P = .045), and a lower prescribed maximum dose (P = .006). CONCLUSION: SRS for bAVMs results in obliteration and avoids permanent complications in the majority of patients.
BACKGROUND: The management of brainstem arteriovenous malformations (bAVMs) is a formidable challenge. bAVMs harbor higher morbidity and mortality compared to other locations. OBJECTIVE: To review the outcomes following stereotactic radiosurgery (SRS) of bAVMs in a multicenter study. METHODS: Six medical centers contributed data from 205 patients through the International Gamma Knife Research Foundation. Median age was 32 yr (6-81). Median nidus volume was 1.4 mL (0.1-69 mL). Favorable outcome (FO) was defined as AVM obliteration and no post-treatment hemorrhage or permanent symptomatic radiation-induced complications. RESULTS: Overall obliteration was reported in 65.4% (n = 134) at a mean follow-up of 69 mo. Obliteration was angiographically proven in 53.2% (n = 109) and on MRA in 12.2% (n = 25). Actuarial rate of obliteration at 2, 3, 5, 7, and 10 yr after SRS was 24.5%, 43.3%, 62.3%, 73%, and 81.8% respectively. Patients treated with a margin dose >20 Gy were more likely to achieve obliteration (P = .001). Obliteration occurred earlier in patients who received a higher prescribed margin dose (P = .05) and maximum dose (P = .041). Post-SRS hemorrhage occurred in 8.8% (n = 18). Annual postgamma knife latency period hemorrhage was 1.5%. Radiation-induced complications were radiologically evident in 35.6% (n = 73), symptomatic in 14.6% (n = 30), and permanent in 14.6% (n = 30, which included long-tract signs and new cranial nerve deficits). FO was achieved in 64.4% (n = 132). Predictors of an FO were a higher Virginia radiosurgery AVM scale score (P = .003), prior hemorrhage (P = .045), and a lower prescribed maximum dose (P = .006). CONCLUSION: SRS for bAVMs results in obliteration and avoids permanent complications in the majority of patients.
Authors: Eric J Lehrer; Arpan V Prabhu; Kunal K Sindhu; Stanislav Lazarev; Henry Ruiz-Garcia; Jennifer L Peterson; Chris Beltran; Keith Furutani; David Schlesinger; Jason P Sheehan; Daniel M Trifiletti Journal: Biomedicines Date: 2021-01-03
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