Nasser Mohammed1, Yi-Chieh Hung1, Ching-Jen Chen1, Zhiyuan Xu1, David Schlesinger1, Hideyuki Kano2, Veronica Chiang3, Judith Hess3, 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 Lunsford4, Jason P Sheehan1. 1. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia. 2. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. School of Medicine, Yale University, New Haven, Connecticut. 4. Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. 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, Royal Oak, Michigan. 8. Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia. 9. Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic. 10. Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico.
Abstract
BACKGROUND: There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS). OBJECTIVE: To design a practical grading system that would predict outcomes after SRS for cranial dAVFs. METHODS: From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified. RESULTS: Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan-Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001). CONCLUSION: The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems.
BACKGROUND: There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS). OBJECTIVE: To design a practical grading system that would predict outcomes after SRS for cranial dAVFs. METHODS: From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified. RESULTS: Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan-Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001). CONCLUSION: The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems.
Authors: Nasser Mohammed; Dale Ding; Yi-Chieh Hung; Zhiyuan Xu; Cheng-Chia Lee; Hideyuki Kano; Roberto Martínez-Álvarez; Nuria Martínez-Moreno; David Mathieu; Mikulas Kosak; Christopher P Cifarelli; Gennadiy A Katsevman; L Dade Lunsford; Mary Lee Vance; Jason P Sheehan Journal: J Neurosurg Date: 2019-04-26 Impact factor: 5.115
Authors: Robert M Starke; David J McCarthy; Ching-Jen Chen; Hideyuki Kano; Brendan McShane; John Lee; David Mathieu; Lucas T Vasas; Anthony M Kaufmann; Wei Gang Wang; Inga S Grills; Mohana Rao Patibandla; Christopher P Cifarelli; Gabriella Paisan; John A Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez-Mercado; Daniel A Tonetti; L Dade Lunsford; Jason P Sheehan Journal: J Neurosurg Date: 2019-01-04 Impact factor: 5.115
Authors: Nasser Mohammed; Yi-Chieh Hung; Zhiyuan Xu; Robert M Starke; Hideyuki Kano; 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: World Neurosurg Date: 2019-02-18 Impact factor: 2.104
Authors: W Y Guo; D H Pan; H M Wu; W Y Chung; C Y Shiau; L W Wang; H J Chiou; M Y Yen; M M Teng Journal: AJNR Am J Neuroradiol Date: 1998 Jun-Jul Impact factor: 3.825