Long-term Outcomes and Imaging Response for Image-Guided Stereotactic Radiosurgery (IG-SRS) of Brain Arteriovenous Malformations (AVM)

2018 ◽  
Vol 102 (3) ◽  
pp. e363
Author(s):  
J. Trotter ◽  
J.P. Kirkpatrick ◽  
F. McSherry ◽  
A. Rodrigues ◽  
M.L. Dworkin ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Long Term Outcomes ◽  
Image Guided ◽  
Brain Arteriovenous Malformations ◽  
Imaging Response

scholarly journals Long-term outcomes of 170 brain arteriovenous malformations treated by frameless image-guided robotic stereotactic radiosurgery

Medicine ◽  
2021 ◽  
Vol 100 (19) ◽  
pp. e25752
Author(s):  
Pritsana Punyawai ◽  
Nicha Radomsutthikul ◽  
Mantana Dhanachai ◽  
Chai Kobkitsuksakul ◽  
Ake Hansasuta
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Long Term Outcomes ◽  
Image Guided ◽  
Brain Arteriovenous Malformations

scholarly journals Stereotactic radiosurgery for pediatric brain arteriovenous malformations: long-term outcomes

2020 ◽  
Vol 25 (5) ◽  
pp. 497-505
Author(s):  
Ching-Jen Chen ◽  
Cheng-Chia Lee ◽  
Hideyuki Kano ◽  
Kathryn N. Kearns ◽  
Dale Ding ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Cyst Formation ◽  
Tumor Formation ◽  
Long Term Outcomes ◽  
Risk Of Death ◽  
Brain Arteriovenous Malformations ◽  
Cumulative Probabilities

OBJECTIVEContrary to the better described obliteration- and hemorrhage-related data after stereotactic radiosurgery (SRS) of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications, including cyst and tumor formation, are limited in the literature. The aim of the present study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric patients (age < 18 years).METHODSThe authors retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database for the years 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for the competing risk of death, were calculated.RESULTSThe study cohort comprised 539 pediatric AVM patients (mean follow-up 85.8 months). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI 58.8%–68.0%), 77.1% (95% CI 72.1%–81.3%), and 88.1% (95% CI 82.5%–92.0%) over 5, 10, and 15 years, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI 3.1%–7.2%), 9.7% (95% CI 6.4%–13.7%), and 14.5% (95% CI 9.5%–20.5%) over 5, 10, and 15 years, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI 2.3%–10.7%) and 6.9% (95% CI 3.1%–12.9%) over 10 and 15 years, respectively. Meningiomas were observed in 2 patients (0.4%) at 10 and 12 years after SRS, with a cumulative probability of 3.1% (95% CI 0.6%–9.7%) over 15 years.CONCLUSIONSAVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 years, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.

scholarly journals Stereotactic Radiosurgery for Pediatric Brain Arteriovenous Malformations: Long-Term Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ching-Jen Chen ◽  
Cheng-Chia Lee ◽  
Kathryn N Kearns ◽  
Dale Ding ◽  
Douglas Kondziolka ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Cyst Formation ◽  
Tumor Formation ◽  
Cumulative Probability ◽  
Long Term Outcomes ◽  
Risk Of Death ◽  
Brain Arteriovenous Malformations ◽  
Cumulative Probabilities

Abstract INTRODUCTION Contrary to the better described obliteration and hemorrhage data after stereotactic radiosurgery (SRS) treatment of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications including cyst and tumor formation are limited in the literature. The aim of the study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric (age < 18 yr) patients. METHODS We retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database from 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for competing risk of death, were calculated. RESULTS The study cohort comprised 539 pediatric AVM patients (mean follow-up: 85.8 mo). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI: 58.8%-68.0%), 77.1% (95% CI: 72.1%-81.3%), and 88.1% (95% CI: 82.5%-92.0%) over 5, 10, and 15 yr, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI: 3.1%-7.2%), 9.7% (95% CI: 6.4%-13.7%), and 14.5% (95% CI: 9.5%-20.5%) over 5, 10, and 15 yr, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI: 2.3%-10.7%) and 6.9% (95% CI: 3.1%-12.9%) over 10 and 15 yr, respectively. Meningioma was observed in 2 patients (0.4%) at 10 and 12 yr after SRS, with cumulative probability of 3.1% (95% CI: 0.6%-9.7%) over 15 yr. CONCLUSION AVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 yr, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.

Long-term Outcomes of Stereotactic Radiosurgery for Arteriovenous Malformations in the Thalamus

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 398-403 ◽  
Author(s):  
Tomoyuki Koga ◽  
Masahiro Shin ◽  
Keisuke Maruyama ◽  
Atsuro Terahara ◽  
Nobuhito Saito
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Morbidity Rate ◽  
Long Term Outcomes ◽  
Surgical Morbidity ◽  
Obliteration Rate ◽  
Planning Software ◽  
Risk Of Hemorrhage

Abstract BACKGROUND Arteriovenous malformations (AVMs) in the thalamus carry a high risk of hemorrhage. Although stereotactic radiosurgery (SRS) is widely accepted because of the high surgical morbidity and mortality of these lesions, precise long-term outcomes are largely unknown. OBJECTIVE To review our experience with SRS for thalamic AVMs based on the latest follow-up data. METHODS Forty-eight patients with thalamic AVMs were treated by SRS using the Leksell Gamma Knife and were followed. Long-term outcomes including the obliteration rate, hemorrhage after treatment, and adverse effects were retrospectively analyzed. RESULTS The annual hemorrhage rate before SRS was 14%. The mean follow-up period after SRS was 66 months (range 6–198 months). The actuarial obliteration rate confirmed by angiography was 82% at 5 years after treatment, and the annual hemorrhage rate after SRS was 0.36%. Factors associated with higher obliteration rates were previous hemorrhage (P = .004) and treatment using new planning software (P = .001). Persistent worsening of neurological symptoms was observed in 17% and more frequently seen in patients who were treated using older planning software (P = .04) and a higher margin dose (P = .02). The morbidity rate for patients who received treatment planned using new software with a margin dose not more than 20 Gy was 12%. CONCLUSION SRS for thalamic AVMs achieved a high obliteration rate and effectively decreased the risk of hemorrhage, with less morbidity compared with other modalities. Longer follow-up to evaluate the risk of delayed complications and the effort to minimize the morbidity is necessary.

Concurrent decompression and resection versus decompression with delayed resection of acutely ruptured brain arteriovenous malformations

2021 ◽  
pp. 1-8
Author(s):  
Rajeev D. Sen ◽  
Isaac Josh Abecassis ◽  
Jason Barber ◽  
Michael R. Levitt ◽  
Louis J. Kim ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Scale Score ◽  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Surgical Decompression ◽  
Low Grade ◽  
Brain Arteriovenous Malformations ◽  
Significant Difference ◽  
Delayed Group

OBJECTIVE Brain arteriovenous malformations (bAVMs) most commonly present with rupture and intraparenchymal hemorrhage. In rare cases, the hemorrhage is large enough to cause clinical herniation or intractable intracranial hypertension. Patients in these cases require emergent surgical decompression as a life-saving measure. The surgeon must decide whether to perform concurrent or delayed resection of the bAVM. Theoretical benefits to concurrent resection include a favorable operative corridor created by the hematoma, avoiding a second surgery, and more rapid recovery and rehabilitation. The objective of this study was to compare the clinical and surgical outcomes of patients who had undergone concurrent emergent decompression and bAVM resection with those of patients who had undergone delayed bAVM resection. METHODS The authors conducted a 15-year retrospective review of consecutive patients who had undergone microsurgical resection of a ruptured bAVM at their institution. Patients presenting in clinical herniation or with intractable intracranial hypertension were included and grouped according to the timing of bAVM resection: concurrent with decompression (hyperacute group) or separate resection surgery after decompression (delayed group). Demographic and clinical characteristics were recorded. Groups were compared in terms of the primary outcomes of hospital and intensive care unit (ICU) lengths of stay (LOSs). Secondary outcomes included complete obliteration (CO), Glasgow Coma Scale score, and modified Rankin Scale score at discharge and at the most recent follow-up. RESULTS A total of 35/269 reviewed patients met study inclusion criteria; 18 underwent concurrent decompression and resection (hyperacute group) and 17 patients underwent emergent decompression only with later resection of the bAVM (delayed group). Hyperacute and delayed groups differed only in the proportion that underwent preresection endovascular embolization (16.7% vs 76.5%, respectively; p < 0.05). There was no significant difference between the hyperacute and delayed groups in hospital LOS (26.1 vs 33.2 days, respectively; p = 0.93) or ICU LOS (10.6 vs 16.1 days, respectively; p = 0.69). Rates of CO were also comparable (78% vs 88%, respectively; p > 0.99). Medical complications were similar in the two groups (33% hyperacute vs 41% delayed, p > 0.99). Short-term clinical outcomes were better for the delayed group based on mRS score at discharge (4.2 vs 3.2, p < 0.05); however, long-term outcomes were similar between the groups. CONCLUSIONS Ruptured bAVM rarely presents in clinical herniation requiring surgical decompression and hematoma evacuation. Concurrent surgical decompression and resection of a ruptured bAVM can be performed on low-grade lesions without compromising LOS or long-term functional outcome; however, the surgeon may encounter a more challenging surgical environment.

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