Nasser Mohammed1, Yi-Chieh Hung1, Zhiyuan Xu1, Robert M Starke2, Hideyuki Kano3, John Lee4, David Mathieu5, Anthony M Kaufmann6, Inga S Grills7, Christopher P Cifarelli8, John A Vargo8, Tomas Chytka9, Ladislava Janouskova9, Caleb E Feliciano10, Rafael Rodriguez Mercado10, L Dade Lunsford3, Jason P Sheehan11. 1. Department of Neurological Surgery, University of Virginia, Virginia, USA. 2. Department of Neurological Surgery, University of Miami, Florida, USA. 3. Department of Neurological Surgery, University of Pittsburgh, Pittsburg, USA. 4. Department of Neurological Surgery, University of Pennsylvania, Philadelphia, USA. 5. Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada. 6. Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada. 7. Department of Radiation Oncology, Beaumont Health System, Michigan, USA. 8. Department of Neurological Surgery, West Virginia University, Morgantown, USA. 9. Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic. 10. Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico. 11. Department of Neurological Surgery, University of Virginia, Virginia, USA. Electronic address: jsheehan@virginia.edu.
Abstract
OBJECTIVE: This study aims to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (dAVFs) in older patients (≥65 years) compared with younger patients (age <65 years). METHODS: Two groups with a total of 96 patients were selected from a database of 133 patients with dAVF from 9 international medical centers with a minimum 6 months follow-up. A 1:2 propensity matching was performed by nearest-neighbor matching criteria based on sex, Borden grade, maximum radiation dose given, and location. The older cohort consisted of 32 patients and the younger cohort consisted of 64 patients. The mean overall follow-up in the combined cohort was 42.4 months (range, 6-210 months). RESULTS: In the older cohort, a transverse sinus location was found to significantly predict dAVF obliteration (P = 0.01). The post-SRS actuarial 3-year and 5-year obliteration rates were 47.7% and 78%, respectively. There were no cases of post-SRS hemorrhage. In the younger cohort, the cavernous sinus location was found to significantly predict obliteration (P = 0.005). The 3-year and 5-year actuarial obliteration rates were 56% and 70%, respectively. Five patients (7.8%) hemorrhaged after SRS. Margin dose ≥25 Gy was predictive of unfavorable outcome. The obliteration rate (P = 0.3), post-SRS hemorrhage rate (P = 0.16), and persistent symptoms after SRS (P = 0.83) were not statistically different between the 2 groups. CONCLUSIONS: SRS achieves obliteration in most older patients with dAVF, with an acceptable rate of complication. There was no increased risk of postradiosurgery complications in the older cohort compared with the younger patients.
OBJECTIVE: This study aims to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (dAVFs) in older patients (≥65 years) compared with younger patients (age <65 years). METHODS: Two groups with a total of 96 patients were selected from a database of 133 patients with dAVF from 9 international medical centers with a minimum 6 months follow-up. A 1:2 propensity matching was performed by nearest-neighbor matching criteria based on sex, Borden grade, maximum radiation dose given, and location. The older cohort consisted of 32 patients and the younger cohort consisted of 64 patients. The mean overall follow-up in the combined cohort was 42.4 months (range, 6-210 months). RESULTS: In the older cohort, a transverse sinus location was found to significantly predict dAVF obliteration (P = 0.01). The post-SRS actuarial 3-year and 5-year obliteration rates were 47.7% and 78%, respectively. There were no cases of post-SRS hemorrhage. In the younger cohort, the cavernous sinus location was found to significantly predict obliteration (P = 0.005). The 3-year and 5-year actuarial obliteration rates were 56% and 70%, respectively. Five patients (7.8%) hemorrhaged after SRS. Margin dose ≥25 Gy was predictive of unfavorable outcome. The obliteration rate (P = 0.3), post-SRS hemorrhage rate (P = 0.16), and persistent symptoms after SRS (P = 0.83) were not statistically different between the 2 groups. CONCLUSIONS:SRS achieves obliteration in most older patients with dAVF, with an acceptable rate of complication. There was no increased risk of postradiosurgery complications in the older cohort compared with the younger patients.
Authors: Christopher P Cifarelli; George Kaptain; Chun-Po Yen; David Schlesinger; Jason P Sheehan Journal: Neurosurgery Date: 2010-11 Impact factor: 4.654
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Authors: Nasser Mohammed; Yi-Chieh Hung; Ching-Jen Chen; Zhiyuan Xu; David Schlesinger; Hideyuki Kano; Veronica Chiang; Judith Hess; John Lee; David Mathieu; Anthony M Kaufmann; Inga S Grills; Christopher P Cifarelli; John A Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez Mercado; L Dade Lunsford; Jason P Sheehan Journal: Neurosurgery Date: 2020-08-01 Impact factor: 4.654