The Role of Biological Effective Dose in Predicting Obliteration After Stereotactic Radiosurgery of Cerebral Arteriovenous Malformations

2021 ◽  
Vol 96 (5) ◽  
pp. 1157-1164
Author(s):  
Cody L. Nesvick ◽  
Christopher S. Graffeo ◽  
Paul D. Brown ◽  
Michael J. Link ◽  
Scott L. Stafford ◽  
...  
Keyword(s):  
Effective Dose ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Biological Effective Dose ◽  
Cerebral Arteriovenous Malformations

Advances in Radiosurgery for Arteriovenous Malformations of the Brain

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S50-S59 ◽  
Author(s):  
Benjamin A. Rubin ◽  
Andrew Brunswick ◽  
Howard Riina ◽  
Douglas Kondziolka
Keyword(s):  
Natural History ◽  
Stereotactic Radiosurgery ◽  
Endovascular Therapy ◽  
Arteriovenous Malformations ◽  
Morbidity And Mortality ◽  
Cerebral Arteriovenous Malformations ◽  
History Of ◽  
The Brain ◽  
Management Algorithms

Abstract Arteriovenous malformations of the brain are a considerable source of morbidity and mortality for patients who harbor them. Although our understanding of this disease has improved, it remains in evolution. Advances in our ability to treat these malformations and the modes by which we address them have also improved substantially. However, the variety of patient clinical and disease scenarios often leads us into challenging and complex management algorithms as we balance the risks of treatment against the natural history of the disease. The goal of this article is to provide a focused review of the natural history of cerebral arteriovenous malformations, to examine the role of stereotactic radiosurgery, to discuss the role of endovascular therapy as it relates to stereotactic radiosurgery, and to look toward future advances.

scholarly journals Application of Single-Stage Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations >10 cm3

Stroke ◽  
2014 ◽  
Vol 45 (12) ◽  
pp. 3543-3548 ◽  
Author(s):  
Shunya Hanakita ◽  
Tomoyuki Koga ◽  
Masahiro Shin ◽  
Hiroshi Igaki ◽  
Nobuhito Saito
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Single Stage ◽  
Cerebral Arteriovenous Malformations

Gamma Knife radiosurgery for acromegaly: Evaluating the role of the biological effective dose associated with endocrine remission in a series of 42 consecutive cases

2020 ◽  
Author(s):  
Anne Balossier ◽  
Constantin Tuleasca ◽  
Christine Cortet‐Rudelli ◽  
Gustavo Soto‐Ares ◽  
Marc Levivier ◽  
...  
Keyword(s):  
Effective Dose ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Biological Effective Dose

scholarly journals Is Biological Effective Dose (BED) Predictive of Outcomes After Radiosurgery for Cerebral Arteriovenous Malformations?

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Cody L Nesvick ◽  
Christopher S Graffeo ◽  
Michael J Link ◽  
Bruce E Pollock
Keyword(s):  
Radiation Dose ◽  
Effective Dose ◽  
Arteriovenous Malformations ◽  
Cox Regression ◽  
Treatment Time ◽  
Continuous Variable ◽  
Biological Effective Dose ◽  
Excellent Outcome

Abstract INTRODUCTION Reports have shown that radiation dose directly correlates with the chance of nidus obliteration after stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs). However, recent studies have shown that the rate of obliteration was greater in patients having SRS before 2000. As the effect of radiation on cell viability is both dose- and time-dependent, one explanation may be that contemporary SRS, which utilizes more isocenters of radiation to improve dose conformality, takes longer to deliver the same radiation dose, thereby reducing its effectiveness. Biological effective dose (BED) is a metric that incorporates both dose and treatment time and has been shown to correlate with enhanced cell kill in Vitro, as well as normal tissue toxicity in animal models. METHODS A retrospective study of patients having single-session AVM SRS between 1990 and 2009 with a minimum of 2 yr follow-up. Excluded were patients having prior radiation or embolization, as well as patients having volume-staged SRS. BED was calculated using the mono-exponential model described by Jones and Hopewell. The primary outcomes of the study were time to obliteration and chance of excellent outcome (nidus obliteration with no new deficits). RESULTS Three hundred twenty-one patients (328 AVMs) met inclusion criteria (median follow-up, 6.7 yr). BED was associated with both decreased time to obliteration and excellent outcome in univariate Cox regression analyses, both when treated as a dichotomous (P = .002, HR = 1.51 for obliteration; P = .001, HR = 1.61 for outcome) or continuous variable (P = .049, HR = 1.002 for obliteration; P = .01, HR = 1.00 for outcome). In multivariable analyses including dichotomized BED and modified Radiosurgery-Based Arteriovenous Malformation Score as covariates, BED remained significantly associated with both time to obliteration (P = .01, HR = 1.46) and excellent outcome (P = .04, HR = 1.40). CONCLUSION BED was predictive of outcomes after AVM SRS. Further study is warranted to determine whether BED optimization should be considered as well as a prescribed treatment dose for SRS treatment planning.

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

2014 ◽  
Vol 37 (3) ◽  
pp. E17 ◽  
Author(s):  
Ching-Jen Chen ◽  
Srinivas Chivukula ◽  
Dale Ding ◽  
Robert M. Starke ◽  
Cheng-Chia Lee ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Case Series ◽  
Outcome Data ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Cerebral Arteriovenous Malformations ◽  
Control Seizure ◽  
Free Status

Object Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs. Methods A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome. Results Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007). Conclusions Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.

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