Abstract 177: Hemodynamics and Anatomic Evaluation of Intracranial Arteriovenous Malformations Using Phase-Contrast Magnetic Resonance Velocimetry

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Warren Chang ◽  
Benjamin Ciske ◽  
Michael Loecher ◽  
Kevin Johnson ◽  
Yijing Wu ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Phase Contrast ◽  
Spline Interpolation ◽  
Significant Risk ◽  
Velocity Data ◽  
Scan Time ◽  
Increased Risk ◽  
Significant Difference ◽  
Feeding Vessels ◽  
Risk Of Hemorrhage

Introduction: Arteriovenous Malformations (AVMs) have a high lifetime risk of hemorrhage; however treatment carries a significant risk of morbidity/mortality. Wall Shear Stress (WSS) and other hemodynamic parameters are shown to be altered in patients with symptomatic AVMs. Analysis of hemodynamics may have value in stratifying patients into different risk groups to prioritize treatment. We have recently implemented PC-VIPR, a phase contrast MRA technique that can acquire whole brain angiograms with scan time of 5 minutes with velocity data. PC-VIPR has sufficient spatial resolution for both hemodynamic analysis and assessment of anatomic features such as Spetzler-Martin grading. Materials & Methods: 10 patients with AVMs were scanned using PC-VIPR; WSS and vessel diameter in vessels feeding the AVMs and in normal contralateral vessels were calculated using PC-VIPR velocity data using automated B-spline interpolation. Spetzler-Martin grading was performed by an experienced neuroradiologist. Results: Patients with an asymptomatic presentation or mild symptoms (n=4) had no significant difference in WSS between ipsilateral feeding vessels and normal contralateral vessels (1.555 N/m2 vs 1.494, p=0.31), and showed significant vessel dilation in feeding vessels when compared to normal contralateral vessels (4.57 mm vs 3.66, p=0.005) while patients presenting with hemorrhage, severe headaches/seizures, or focal neurologic deficits (n=6) had significantly higher WSS in feeders compared to contralateral vessels (1.607 N/m2 vs 1.146, p=0.003) but the increase in vessel dilation was not statistically significant. (4.34 vs 3.84, p=0.11) Spetzler-Martin grading was performed in all patients and correlated with grading performed via digital subtraction angiography in all cases. Discussion: In this study we demonstrate that both hemodynamic analysis and Spetzler-Martin grading can be obtained non-invasively in patients with AVMs using PC-VIPR. Variation in WSS between feeders and normal vessels appeared to relate to the clinical presentation of the patient. Figure 1a shows a WSS map of a patient with mild stable symptoms demonstrating similar WSS in feeders compared to contralateral vessels, Figure 1b shows a WSS map of a patient presenting with hemorrhage with higher WSS in feeders compared to contralateral vessels. Several reports suggest high WSS in AVM feeders stimulates compensatory dilation, normalizing WSS. Hemodynamic analysis using PC-VIPR may have value in risk stratification by identifying patients in which compensation has not yet occurred, with increased risk of hemorrhage.

scholarly journals Cyclin D1 G870A Variant is Associated with Increased Risk of Microsatellite Instability-Positive Colorectal Cancer in Young Male Patients

2007 ◽  
Vol 10 (2) ◽  
pp. 29-36
Author(s):  
T Josifovski ◽  
N Matevska ◽  
M Hiljadnikova-Bajro ◽  
Z Sterjev ◽  
A Kapedanovska ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Microsatellite Instability ◽  
Cyclin D1 ◽  
Regulatory Protein ◽  
Significant Risk ◽  
Young Male ◽  
Genotype Distribution ◽  
Increased Risk ◽  
Significant Difference ◽  
Male Patients

Cyclin D1 G870A Variant is Associated with Increased Risk of Microsatellite Instability-Positive Colorectal Cancer in Young Male PatientsCyclin D1 (CCND1) is a cell cycle regulatory protein, which is often over expressed in human tumors and is associated with cell proliferation and poor prognosis. A common G870A single nucleotide polymorphism at codon 242 in exon 4 of the CCND1 gene is associated with an altered messenger RNA transcript and increased risk of colorectal cancer (CRC) and adenoma in some studies. Over expression of CCND1 modifies the effect of mutations in mismatch repair (MMR) genes, enhances microsatellite instability (MSI), and influences the age ofonset of hereditary non polyposis colorectal cancer (HNPCC). We have extended our study that indicated that the CCND1 A variant may influence the age of onset of CRC in the Macedonian population only in patients who exhibit MSI tumors by a case control study of 331 randomly selected CRC patients and 101 controls without clinical diagnosis of CRC. We did not observe a significant difference in overall allelic frequencies and genotype distribution of affected and unaffected mutation carriers, but found a statistically significant risk of CRC in carriers of the CCND1 A allele when patients were grouped according to gender, age and MSI status. A higher risk was observed in patients with MSI-positive tumors and particularly in male patients under 60 years of age. The consequences of the above observation were reversed in female patients. These results indicate that the CCND1 A variant may enhance CRC progression through a pathway influenced by estrogens in colonic epithelia.

High-grade proteinuria associated with bevacizumab in patients with renal cell cancer and non-renal cell cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16089-e16089
Author(s):  
C. Y. Kim ◽  
D. Chu ◽  
L. Baer ◽  
S. Wu
Keyword(s):  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Significant Risk ◽  
Close Monitoring ◽  
Tumor Type ◽  
High Grade ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Significant Difference

e16089 Background: Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor. It is a widely used angiogenesis inhibitor in the treatment of renal cell cancer (RCC) and other solid tumors. Proteinuria is associated with significant morbidity and treatment interruptions. The overall risk for proteinuria is unclear. This study was conducted to determine the risk of developing proteinuria among RCC and non-RCC patients receiving bevacizumab. Methods: Databases from PUBMED and Web Science from January 1966 until July 2008 and abstracts presented at ASCO from January 2000 to July 2008 were searched to identify relevant studies. Studies included randomized controlled clinical trials in which standard anti-neoplastic therapy was administered with and without bevacizumab with available data for proteinuria. Summary incidence rate, relative risk (RR), and 95% confidence interval (CI) were calculated employing fixed or random effect models based upon the heterogeneity of included studies. Results: A total of 6,702 patients from 14 randomized controlled studies were included for analysis. The incidence of all-grade proteinuria in patients receiving bevacizumab was 19.3% (95% CI: 11.9–29.6%) with 2.3% (95% CI: 1.2–4.1%) being high-grade (grade 3 or 4). Patients treated with bevacizumab had an increased risk of developing high-grade proteinuria with RR of 6.3 (95% CI: 4.0–9.9) compared with controls. Risk may vary with dose of bevacizumab; significant difference may exist in patients receiving bevacizumab at 5 mg/kg/week (RR 9.1, 95% CI: 4.3–19.6, p < 0.001) and 2.5 mg/kg/week (RR = 5.1, 95%CI: 3.0–8.8, p < 0.001). The risk of high-grade proteinuria may also depend on tumor type; the incidence of high-grade proteinuria was 10.0% (95% CI: 4.3–22.4%) with a RR 48.7 (95% CI: 9.7–244.3) among 703 RCC patients compared with an incidence of 1.7% (95% CI: 0.09–3.2%) and RR of 5.2 (95% CI: 3.3–8.4) among 5,999 non-RCC patients. Conclusions: There is a significant risk for high-grade proteinuria in patients receiving bevacizumab. The risk may vary with bevacizumab dose and tumor type. RCC patients may have higher risk than non-RCC patients. Close monitoring and management are recommended for patients at high risk. No significant financial relationships to disclose.

scholarly journals Carbohydrate-Rich Diet Is Associated with Increased Risk of Incident Chronic Kidney Disease in Non-Diabetic Subjects

2019 ◽  
Vol 8 (6) ◽  
pp. 793 ◽  
Author(s):  
Ki Heon Nam ◽  
Seong Yeong An ◽  
Young Su Joo ◽  
Sangmi Lee ◽  
Hae-Ryong Yun ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Significant Risk ◽  
Carbohydrate Intake ◽  
Dietary Carbohydrate ◽  
Increased Risk ◽  
Significant Difference ◽  
Incident Chronic Kidney Disease ◽  
The Impact

Despite the potential relationship with metabolic derangements, the association between dietary carbohydrate intake and renal function remains unknown. The present study investigated the impact of dietary carbohydrate intake on the development of incident chronic kidney disease (CKD) in a large-scale prospective cohort with normal renal function. A total of 6746 and 1058 subjects without and with diabetes mellitus (DM) were analyzed, respectively. Carbohydrate intake was assessed by a 24-h dietary recall food frequency questionnaire. The primary endpoint was CKD development, defined as a composite of estimated glomerular filtration rate (eGFR) of ≤60 mL/min/1.73 m2 and the development of proteinuria. CKD newly developed in 20.1% and 36.0% of subjects during median follow-ups of 140 and 119 months in the non-DM and DM subjects, respectively. Categorization of non-DM subjects into dietary carbohydrate density quartiles revealed a significantly higher risk of CKD development in the third and fourth quartiles than in the first quartile (P = 0.037 for first vs. third; P = 0.001 for first vs. fourth). A significant risk elevation was also found with increased carbohydrate density when carbohydrate density was treated as a continuous variable (P = 0.008). However, there was no significant difference in the incident CKD risk among those with DM according to dietary carbohydrate density quartiles. Carbohydrate-rich diets may increase the risk of CKD development in non-DM subjects.

scholarly journals Pipeline Flex Embolization of Flow-Related Aneurysms Associated with Arteriovenous Malformations: A Case Report

2018 ◽  
Vol 7 (3-4) ◽  
pp. 164-170
Author(s):  
Narlin B. Beaty ◽  
Jessica K. Campos ◽  
Geoffrey P. Colby ◽  
Li-Mei Lin ◽  
Matthew T. Bender ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Treatment Strategies ◽  
Flow Diverter ◽  
Case Presentation ◽  
Increased Risk ◽  
Feeding Vessels ◽  
Eloquent Cortex

Background: An estimated 0.1% of the population harbors brain arteriovenous malformations (AVMs). Diagnosis and workup of AVMs include thorough evaluation for characterization of AVM angioarchitecture and careful assessment for concomitant aneurysms. The presence of coexisting aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year compared to patients with AVMs alone with a risk of 3%. Comprehensive AVM management requires recognition of concomitant aneurysms and prioritizes treatment strategies to mitigate the aggregate risk of intracranial hemorrhage associated with AVM rupture in patients with coexisting aneurysms. Endovascular treatment of these flow-related aneurysms can offer a cure, while avoiding open surgery. Successful flow-diverting embolization techniques, efficacy, and outcomes have been previously described for a variety of aneurysm types and locations. However, use of a flow diverter has not been previously described for the treatment of high-flow aneurysms on AVM-feeding vessels. Case Presentation: We report 2 cases of large AVMs within eloquent cortex associated with flow-related aneurysms in patients presenting initially with suspected intracerebral hemorrhage secondary to AVM rupture. Discussion: No consensus currently exists to guide treatment of intracranial aneurysms associated with AVMs. Surgical management addressed AVM embolization initially, as the vasculopathology with the highest rupture risk. Subsequently, Pipeline embolization of the associated aneurysms with adequate antiplatelet treatment was performed before scheduled radiosurgery to decrease the risk of AVM rupture or rebleed. This represents a novel and promising use of the Pipeline Embolization Device. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

scholarly journals Aspirin for primary prevention of stroke in traumatic cerebrovascular injury: association with increased risk of transfusion

2019 ◽  
Vol 130 (5) ◽  
pp. 1520-1527 ◽  
Author(s):  
Russell L. Griffin ◽  
Stephanie R. Falatko ◽  
Stella Aslibekyan ◽  
Virginia Strickland ◽  
Mark R. Harrigan
Keyword(s):  
Ischemic Stroke ◽  
Blunt Trauma ◽  
Age Groups ◽  
Significant Risk ◽  
Antiplatelet Agents ◽  
Packed Red Blood Cells ◽  
Cerebrovascular Injury ◽  
Increased Risk ◽  
Negative Findings ◽  
Risk Of Hemorrhage

OBJECTIVEBlunt traumatic extracranial carotid or vertebral artery injury (i.e., traumatic cerebrovascular injury [TCVI]) occurs in 1%–2% of all blunt trauma admissions, carries a 10% risk of thromboembolic ischemic stroke, and accounts for up to 9600 strokes annually in the US. Screening CT angiograms (CTAs) of patients with trauma has become ubiquitous in recent years, and patients with initially asymptomatic TCVI are commonly treated with antiplatelet agents to prevent stroke. Prophylaxis with antiplatelets is thought to be safer than anticoagulation, which carries a significant risk of hemorrhage in patients with trauma. However, the risk of hemorrhagic complications due to antiplatelets has not been assessed in this population.METHODSThis is a retrospective cohort study of patients in whom a screening CTA was obtained after admission for blunt trauma at a Level 1 trauma center. Patients with CTAs indicating TCVI were treated routinely with 325 mg aspirin daily. The risk of transfusion > 24 hours after admission was compared according to CTA findings (CTA+ or CTA− for positive or negative findings, respectively) and aspirin treatment (ASA+ or ASA− for treatment or no treatment, respectively).RESULTSThe mean overall transfusion amount (number of units of packed red blood cells [PRBCs]) was 0.9 ± 2.1 for CTA+/ASA+ patients (n = 196) and 0.3 ± 1.60 for CTA−/ASA− patients (n = 2290) (p < 0.0001). In adjusted models, the overall relative risk (RR) of PRBC transfusion was 1.70 (1.32–2.20) for CTA+/ASA+ patients compared with CTA−/ASA− patients. Among age groups, participants whose ages were 50–69 years had the greatest significantly elevated RR (1.71, 95% CI 1.08–2.72) for CTA+/ASA+ patients compared with CTA−/ASA− patients.CONCLUSIONSTreatment with aspirin for the prevention of stroke in patients with initially asymptomatic TCVI carries a significantly increased risk of PRBC transfusion. Future studies are needed to determine if this risk is offset by a reduced risk of ischemic stroke.

scholarly journals Management of Pediatric Intracranial Arteriovenous Malformations: Experience With Multimodality Therapy

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 540-556 ◽  
Author(s):  
Tim E Darsaut ◽  
Raphael Guzman ◽  
Mary L Marcellus ◽  
Michael S Edwards ◽  
Lu Tian ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Arteriovenous Malformations ◽  
Significant Risk ◽  
Neurological Complications ◽  
Multimodality Therapy ◽  
Low Grade ◽  
High Grade ◽  
Grade 5 ◽  
Risk Of Hemorrhage

Abstract BACKGROUND: Successful management of pediatric arteriovenous malformations (AVMs) often requires a balanced application of embolization, surgery, and radiosurgery. OBJECTIVE: To describe our experience treating pediatric AVMs. METHODS: We analyzed 120 pediatric patients (&lt; 18 years of age) with AVMs treated with various combinations of radiosurgery, surgery, and endovascular techniques. RESULTS: Between 1985 and 2009, 76 children with low Spetzler-Martin grade (1–3) and 44 with high-grade (4–5) AVMs were treated. Annual risk of hemorrhage from presentation to initial treatment was 4.0%, decreasing to 3.2% after treatment initiation until confirmed obliteration. Results for AVM obliteration were available in 101 patients. Initial single-modality therapy led to AVM obliteration in 51 of 67 low-grade (76%) and 3 of 34 high-grade (9%) AVMs, improving to 58 of 67 (87%) and 9 of 34 (26%), respectively, with further treatment. Mean time to obliteration was 1.8 years for low-grade and 6.4 years for high-grade AVMs. Disabling neurological complications occurred in 4 of 77 low-grade (5%) and 12 of 43 high-grade (28%) AVMs. At the final clinical follow-up (mean, 9.2 years), 48 of 67 patients (72%) with low-grade lesions had a modified Rankin Scale score (mRS) of 0 to 1 compared with 12 of 34 patients (35%) with high-grade AVMs. On multivariate analysis, significant risk factors for poor final clinical outcome (mRS ≥ 2) included baseline mRS ≥ 2 (odds ratio, 9.51; 95% confidence interval, 3.31-27.37; P &lt; .01), left-sided location (odds ratio, 3.03; 95% confidence interval, 1.11-8.33; P = .03), and high AVM grade (odds ratio, 4.35; 95% confidence interval, 1.28-14.28; P = .02). CONCLUSION: Treatment of pediatric AVMs with multimodality therapy can substantially improve obliteration rates and may decrease AVM hemorrhage rates. The poor natural history and risks of intervention must be carefully considered when deciding to treat high-grade pediatric AVMs.

Preoperative Balloon Occlusion of Arteriovenous Malformations

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 301-308 ◽  
Author(s):  
V. Van Halbach ◽  
Randall T. Higashida ◽  
Peter Yang ◽  
Stan Barnwell ◽  
Charles B. Wilson ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Vascular Anatomy ◽  
Balloon Occlusion ◽  
Neurological Deficits ◽  
Permanent Occlusion ◽  
Feeding Vessels ◽  
Normal Perfusion Pressure Breakthrough ◽  
Surgical Adjunct ◽  
Risk Of Hemorrhage

Abstract Many materials have been utilized to embolize cerebral arteriovenous malformations (AVMs) preoperatively. Specific vascular anatomy with large feeding vessels deep to the nidus or aneurysms within feeding arteries favor the use of detachable balloons over other embolic agents. Detachable balloons allow test occlusion of a vascular pedicle before permanent occlusion and can obliterate aneurysms in feeding arteries. We describe 36 feeder arterial balloon occlusions performed in 31 patients. Twenty-nine patients subsequently had surgical resection. None of the patients developed normal perfusion pressure breakthrough or required blood transfusions. The preoperative balloon occlusion was judged by the neurosurgeon to decrease significantly the difficulty in surgical resection of the malformation. The remaining 2 patients underwent embolization before radiosurgery. One patient had aneurysms in the feeding artery, which was balloon-occluded to diminish the risk of hemorrhage. There were two neurological deficits and three asymptomatic arterial dissections related to the balloon procedure. Balloon occlusion of feeding arterial pedicles in selected cerebral AVMs may be a valuable surgical adjunct. (Neurosurgery 22:301-308, 1988)

Risk of rash associated with lenalidomide in multiple myeloma and myelodisplastic syndrome: A systematic review of the literature and meta-analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18571-e18571
Author(s):  
Benjamin C Garden ◽  
Beatrice Nardone ◽  
Shenhong Wu ◽  
Dennis P. West ◽  
Romala Emmanuel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Multiple Myeloma ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Significant Risk ◽  
High Grade ◽  
Increased Risk ◽  
Significant Difference ◽  
Grade 3

e18571 Background: Indications of lenalidomide (Len) include treatment of multiple myeloma (MM) in combination with dexamethasone (Dex) and myelodyplastic syndrome (MDS). The reported incidence and risk of rash varies widely and has been inconsistently reported in trials. Therefore, we conducted a systematic review and meta-analysis of the literature to determine the incidence and risk of developing rash. Methods: Relevant studies were identified from PubMed (1998-2011), abstracts presented at ASCO conferences (2004-2011) and the Web of Science database (1998-2011). Eligible studies were limited to prospective Phase II-III clinical trials in which patients received daily Len doses of either 10mg or 25 mg with or without 40mg of Dex. Incidence, relative risk (RR), and 95% confidence intervals (CI) were calculated using random-effects or fixed-effects models based on heterogeneity of included studies. Results: Data from a total of 1,127 patients in 15 trials were available for analysis. The overall incidence of all-grade and high-grade (grade ≥3) rash was 29.9% (95% CI: 24.8- 35.5) and 3.8% (95% CI: 2.7-5.5), respectively. Len was associated with increased risk of all-grade rash (RR=1.7, 95% CI: 1.3-2.3; P<0.001) when compared to patients treated with a placebo and Dex. Risk of high-grade rash was increased (RR=3.7, 95% CI: 0.8-16.0) with a trend toward statistical significance (P=0.08). No significant difference in incidence of all-grade rash between patients receiving LEN doses of 10mg or 25mg (25.6%, 95% CI: 19.6-32.8% vs. 30.8%, 95% CI: 24.7-37.7%, respectively, p=0.28) was observed. Similarly, no difference was observed between patients receiving LEN monotherapy or in combination with Dex (31.0%, 95% CI: 26.6-43.3% and 23.8%, 95% CI: 14.9-35.8%, respectively, p=0.17). Conclusions: Patients with MM or MDS who are treated with Len are at significant risk for developing rash. The risk appears to be independent of LEN dosage or in combination with Dex. Further studies for prevention and treatment of this untoward toxicity are needed in order to maintain patient’s quality of life and minimize the need for dose modification, all of which may impact clinical outcome.

scholarly journals Hydrocephalus after arteriovenous malformation rupture

2013 ◽  
Vol 34 (5) ◽  
pp. E11 ◽  
Author(s):  
Bradley A. Gross ◽  
Pui Man Rosalind Lai ◽  
Rose Du
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Arteriovenous Malformations ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Long Term Outcome ◽  
Gcs Score ◽  
Risk Of Hemorrhage ◽  
Shunt Dependence

Object The rates and risk factors for external ventricular drain (EVD) placement and long-term shunt dependence in patients with ruptured arteriovenous malformations (AVMs) have not been systematically studied. In this study the authors evaluated the rates of EVD placement and shunt dependence, and risk factors for them, in a cohort of patients with ruptured AVMs. Methods The records of 87 consecutive patients with ruptured AVMs were reviewed for patient demographics, hemorrhage pattern, AVM angioarchitectural features, and surgical treatment. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors for EVD placement, permanent shunt dependence, and long-term outcome (as measured by the modified Rankin Scale). Results Thirty-eight patients (44%) required EVD placement, and 16 (18%) required a permanent shunt. Statistically significant risk factors for EVD placement in the univariate analysis included initial Glasgow Coma Scale (GCS) score (p = 0.002), the presence of intraventricular hemorrhage (IVH; p < 0.001), AVM-associated aneurysms (p = 0.002), and early surgery (p = 0.01). Multivariate analysis revealed only AVM-associated aneurysms as statistically significant (p = 0.006). Risk factors for shunt placement included initial GCS score (p = 0.003), IVH (p = 0.01), deep supratentorial location (p = 0.034), and associated aneurysms (p = 0.03). Multivariate analysis revealed initial GCS score as a statistically significant risk factor (p = 0.041) as well as a strong trend for associated aneurysms (p = 0.06). Patient age, sex, associated subarachnoid hemorrhage, AVM grade, AVM size, and deep venous drainage were not associated with EVD placement or long-term shunt dependence. Conclusions Hydrocephalus from AVM rupture was associated with initial GCS score, IVH, and AVM-associated aneurysms. Arteriovenous malformations with associated aneurysms thus not only have a greater risk of hemorrhage but also a greater risk of hemorrhage-associated morbidity as a result of hydrocephalus.

Gamma Knife Radiosurgery for Incidental, Symptomatic Unruptured, and Ruptured Brain Arteriovenous Malformations

2021 ◽  
Vol 50 (2) ◽  
pp. 222-230
Author(s):  
Byung Sup Kim ◽  
Je Young Yeon ◽  
Hyung Shik Shin ◽  
Jong-Soo Kim ◽  
Seung-Chyul Hong ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Venous Drainage ◽  
Age At Diagnosis ◽  
Significant Difference ◽  
Ruptured Avm ◽  
The Mean ◽  
Risk Of Hemorrhage ◽  
Brain Avms

Background: This study was performed to investigate clinical characteristics and outcome after gamma knife radiosurgery (GKS) in patients with incidental, symptomatic unruptured, or ruptured arteriovenous malformations (AVMs). Methods: A total of 491 patients with brain AVMs treated with GKS from June 2002 to September 2017 were retrospectively reviewed. All patients were classified into the incidental (n = 105), symptomatic unruptured (n = 216), or ruptured AVM (n = 170) groups. Results: The mean age at diagnosis of incidental, symptomatic unruptured, and ruptured AVMs was 40.3, 36.7, and 27.6 years, respectively. The mean nidus volume was 3.9, 5.7, and 2.4 cm3, respectively. Deep venous drainage was identified in 34, 54, and 76% patients, respectively. There were no significant differences in obliteration rates after GKS between the 3 groups (64.8, 61.1, and 65.9%, respectively) after a mean follow-up period of 60.5 months; however, patients with incidental AVM had a significantly lower post-GKS hemorrhage rate than patients with symptomatic unruptured or ruptured AVMs (annual hemorrhage rate of 1.07, 2.87, and 2.69%; p = 0.028 and p = 0.049, respectively). Conclusions: There is a significant difference in clinical and anatomical characteristics between incidental, symptomatic unruptured, and ruptured AVMs. The obliteration rate after GKS is not significantly different between the 3 groups. Meanwhile, an older age at diagnosis and lower hemorrhage rate after GKS in incidental AVMs suggest that they have a more indolent natural course with a lower life-long risk of hemorrhage.

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