The Irradiated Brain Volume Within 12 Gy Is a Predictor for Radiation-Induced Changes After Stereotactic Radiosurgery in Patients With Unruptured Cerebral Arteriovenous Malformations

2021 ◽  
Author(s):  
Huai-Che Yang ◽  
Hsiu-Mei Wu ◽  
Syu-Jyun Peng ◽  
Cheng-Chia Lee ◽  
Yu-Wei Chen ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Brain Volume ◽  
Cerebral Arteriovenous Malformations ◽  
Radiation Induced ◽  
Induced Changes

scholarly journals Repeat Gamma Knife Surgery for Incompletely Obliterated Cerebral Arteriovenous Malformations

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Chun-Po Yen ◽  
Surbhi Jain ◽  
Iftikhar-ul Haq ◽  
Jay Jagannathan ◽  
David Schlesinger ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Cerebral Arteriovenous Malformations ◽  
Radiation Induced ◽  
Induced Changes

Abstract OBJECTIVE The causes of failure after an initial Gamma procedure were studied, along with imaging and clinical outcomes, in a series of 140 patients with cerebral arteriovenous malformations (AVMs) treated with repeat Gamma Knife surgery (GKS). METHODS Causes of initial treatment failure included inaccurate nidus definition in 14 patients, failure to fill part of the nidus as a result of hemodynamic factors in 16, recanalization of embolized AVM compartments in 6, and suboptimal dose (< 20 Gy) in 23. Nineteen patients had repeat GKS for subtotal obliteration of AVMs. In 62 patients, the AVM failed to obliterate despite correct target definition and adequate dose. At the time of retreatment, the nidus volume ranged from 0.1 to 6.9 cm3 (mean, 1.4 cm3), and the mean prescription dose was 20.3 Gy. RESULTS Repeat GKS yielded a total angiographic obliteration in 77 patients (55%) and subtotal obliteration in 9 (6.4%). In 38 patients (27.1%), the AVMs remained patent, and in 16 patients (11.4%), no flow voids were observed on magnetic resonance imaging. Clinically, 126 patients improved or remained stable, and 14 experienced deterioration (8 resulting from a rebleed, 2 caused by persistent arteriovenous shunting, and 4 related to radiation-induced changes). CONCLUSION By using repeat GKS, we achieved a 55% angiographic cure rate. Although radiation-induced changes as visualized on magnetic resonance imaging occurred in 48 patients (39%), only 4 patients (3.6%) developed permanent neurological deficits. These findings may be useful in deciding the management of AVMs in whom total obliteration after initial GKS was not achieved.

Volume-staged versus dose-staged stereotactic radiosurgery outcomes for large brain arteriovenous malformations: a systematic review

2018 ◽  
Vol 128 (1) ◽  
pp. 154-164 ◽  
Author(s):  
Adeel Ilyas ◽  
Ching-Jen Chen ◽  
Dale Ding ◽  
Davis G. Taylor ◽  
Shayan Moosa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Management Strategy ◽  
Individual Patient Data ◽  
Brain Arteriovenous Malformations ◽  
Large Brain ◽  
Radiation Induced ◽  
The Mean ◽  
Induced Changes

OBJECTIVESeveral recent studies have improved our understanding of the outcomes of volume-staged (VS) and dose-staged (DS) stereotactic radiosurgery (SRS) for the treatment of large (volume > 10 cm3) brain arteriovenous malformations (AVMs). In light of these recent additions to the literature, the aim of this systematic review is to provide an updated comparison of VS-SRS and DS-SRS for large AVMs.METHODSA systematic review of the literature was performed using PubMed to identify cohorts of 5 or more patients with large AVMs who had been treated with VS-SRS or DS-SRS. Baseline data and post-SRS outcomes were extracted for analysis.RESULTSA total of 11 VS-SRS and 10 DS-SRS studies comprising 299 and 219 eligible patients, respectively, were included for analysis. The mean obliteration rates for VS-SRS and DS-SRS were 41.2% (95% CI 31.4%–50.9%) and 32.3% (95% CI 15.9%–48.8%), respectively. Based on pooled individual patient data, the outcomes for patients treated with VS-SRS were obliteration in 40.3% (110/273), symptomatic radiation-induced changes (RICs) in 13.7% (44/322), post-SRS hemorrhage in 19.5% (50/256), and death in 7.4% (24/323); whereas the outcomes for patients treated with DS-SRS were obliteration in 32.7% (72/220), symptomatic RICs in 12.2% (31/254), post-SRS hemorrhage in 10.6% (30/282), and death in 4.6% (13/281).CONCLUSIONSVolume-staged SRS appears to afford higher obliteration rates than those achieved with DS-SRS, although with a less favorable complication profile. Therefore, VS-SRS or DS-SRS may be a reasonable treatment approach for large AVMs, either as stand-alone therapy or as a component of a multimodality management strategy.

104 Stereotactic Radiosurgery for Spetzler-Martin Grade IV and V Arteriovenous Malformations: An International Multicenter Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 220-221
Author(s):  
Jason P Sheehan ◽  
Mohana Rao Patibandla ◽  
Dale Ding ◽  
Hideyuki Kano ◽  
Zhiyuan Xu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Independent Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Single Session ◽  
Radiation Induced ◽  
International Multicenter Study ◽  
Induced Changes

Abstract INTRODUCTION Due to the complexity of Spetzler-Martin (SM) grade IV-V arteriovenous malformations (AVM), the management of these lesions remains controversial. The aims of this multicenter, retrospective study are to evaluate outcomes after single-session stereotactic radiosurgery (SRS) for SM grade IV-V AVMs and determine predictive factors. METHODS We pooled data from 233 patients (mean age 33 years) with SM grade IV (94.4%) or V AVMs (5.6%) treated with single-session SRS at eight participating centers in the International Gamma Knife Research Foundation. Pre-SRS embolization was performed in 71 AVMs (30.5%). The mean nidus volume, SRS margin dose, and follow-up duration were 9.7 cc, 17.3 Gy, and 84.5 months, respectively. RESULTS >At a mean follow-up interval of 84.5 months, favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes (RIC) and was achieved in 26.2% of patients. The actuarial obliteration rates at 3, 7, 10, and 12 years were 15%, 34%, 37% and 42%, respectively. The annual post-SRS hemorrhage rate was 3.0%. Symptomatic and permanent RIC occurred in 10.7% and 4% of the patients, respectively. Only larger AVM diameter (P = 0.04) found to be an independent predictor of unfavorable outcome in the multivariate logistic regression analysis. The rate of favorable outcome was significantly lower for unruptured SM grade IV-V AVMs compared to ruptured ones (P = 0.042). Prior embolization was a negative independent predictor of AVM obliteration (P = 0.024) and radiologically evident RIC (P = 0.05) in multivariate analyses. CONCLUSION In this multi-institutional study, single session SRS had limited efficacy in the management of SM grade IV-V AVMs Favorable outcome was only achieved in a minority of unruptured SM grade IV-V AVMs, which supports less frequent utilization of SRS for the management of these lesions. A volume staged SRS approach for large AVMs represents an alternative approach for high grade AVM’s, but it requires further investigation.

scholarly journals Stereotactic radiosurgery for Spetzler-Martin Grade IV and V arteriovenous malformations: an international multicenter study

2018 ◽  
Vol 129 (2) ◽  
pp. 498-507 ◽  
Author(s):  
Mohana Rao Patibandla ◽  
Dale Ding ◽  
Hideyuki Kano ◽  
Zhiyuan Xu ◽  
John Y. K. Lee ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Independent Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Single Session ◽  
Radiation Induced ◽  
International Multicenter Study ◽  
Induced Changes

OBJECTIVEDue to the complexity of Spetzler-Martin (SM) Grade IV–V arteriovenous malformations (AVMs), the management of these lesions remains controversial. The aims of this multicenter, retrospective cohort study were to evaluate the outcomes after single-session stereotactic radiosurgery (SRS) for SM Grade IV–V AVMs and determine predictive factors.METHODSThe authors retrospectively pooled data from 233 patients (mean age 33 years) with SM Grade IV (94.4%) or V AVMs (5.6%) treated with single-session SRS at 8 participating centers in the International Gamma Knife Research Foundation. Pre-SRS embolization was performed in 71 AVMs (30.5%). The mean nidus volume, SRS margin dose, and follow-up duration were 9.7 cm3, 17.3 Gy, and 84.5 months, respectively. Statistical analyses were performed to identify factors associated with post-SRS outcomes.RESULTSAt a mean follow-up interval of 84.5 months, favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes (RIC) and was achieved in 26.2% of patients. The actuarial obliteration rates at 3, 7, 10, and 12 years were 15%, 34%, 37%, and 42%, respectively. The annual post-SRS hemorrhage rate was 3.0%. Symptomatic and permanent RIC occurred in 10.7% and 4% of the patients, respectively. Only larger AVM diameter (p = 0.04) was found to be an independent predictor of unfavorable outcome in the multivariate logistic regression analysis. The rate of favorable outcome was significantly lower for unruptured SM Grade IV–V AVMs compared with ruptured ones (p = 0.042). Prior embolization was a negative independent predictor of AVM obliteration (p = 0.024) and radiologically evident RIC (p = 0.05) in the respective multivariate analyses.CONCLUSIONSIn this multi-institutional study, single-session SRS had limited efficacy in the management of SM Grade IV–V AVMs. Favorable outcome was only achieved in a minority of unruptured SM Grade IV–V AVMs, which supports less frequent utilization of SRS for the management of these lesions. A volume-staged SRS approach for large AVMs represents an alternative approach for high-grade AVMs, but it requires further investigation.

scholarly journals In Reply: Radiation-Induced Changes After Stereotactic Radiosurgery for Brain Arteriovenous Malformations

Neurosurgery ◽  
2017 ◽  
Vol 82 (3) ◽  
pp. E77-E78
Author(s):  
Adeel Ilyas ◽  
Ching-Jen Chen ◽  
Dale Ding ◽  
Thomas J Buell ◽  
Cheng-Chia Lee ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations ◽  
Radiation Induced ◽  
Induced Changes
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