A Comprehensive Study of Symptomatic Late Radiation-Induced Complications After Radiosurgery for Brain Arteriovenous Malformation: Incidence, Risk Factors, and Clinical Outcomes

Hasegawa, Hirotaka; Hanakita, Shunya; Shin, Masahiro; Sugiyama, Takehiro; Kawashima, Mariko; Takahashi, Wataru; Shojima, Masaaki; Ishikawa, Osamu; Nakatomi, Hirofumi; Saito, Nobuhito

doi:10.1016/j.wneu.2018.05.038

Cited by 15 publications

(13 citation statements)

References 43 publications

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“…Since the late 1990s, an increasing number of studies have described late RAEs, including cyst formation (CF), chronic encapsulated hematoma (CEH), and tumorigenesis 59. Radiation-induced chronic inflammation appears to play an important role in the former two conditions,60,61 suggesting that target size is strongly associated with their occurrence 62–64. The other risk factors include lobar location, higher prescription dose, and history of embolization as pre-GKRS factors, the occurrence of early edema, additional irradiation, and the state of nidus obliteration as post-GKRS factors 63–71.…”

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

“…The other risk factors include lobar location, higher prescription dose, and history of embolization as pre-GKRS factors, the occurrence of early edema, additional irradiation, and the state of nidus obliteration as post-GKRS factors 63–71. CF/CEH develops approximately 6.5–11.8 years after irradiation, and the cumulative incidences are estimated to range from 2.8–7.7% at 10 years and 7.6–12.5% at 15 years 64–,66,68. Though the optimal treatment remains a source of controversy, surgical resection is widely regarded as a standard option.…”

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

“…Though the optimal treatment remains a source of controversy, surgical resection is widely regarded as a standard option. However, fluid diversion, including cyst-peritoneal shunt and ommaya reservoir placement, are minimally invasive alternatives for exclusively cystic lesions 64–66,68. Oral corticosteroids may help reduce the associated edema and alleviate symptoms; however, the long-term effects remain unknown 64,68.…”

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

“…However, fluid diversion, including cyst-peritoneal shunt and ommaya reservoir placement, are minimally invasive alternatives for exclusively cystic lesions 64–66,68. Oral corticosteroids may help reduce the associated edema and alleviate symptoms; however, the long-term effects remain unknown 64,68. Previous studies on CF/CEH are summarized in Table 1 62–64,66–68,72–74…”

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

“…Oral corticosteroids may help reduce the associated edema and alleviate symptoms; however, the long-term effects remain unknown 64,68. Previous studies on CF/CEH are summarized in Table 1 62–64,66–68,72–74Table 1Literature Review On Late RAEs (Studies With ≥ 100 patients)AuthorYearNMedian Observation Period (y)Definition Of Late RAEsIncidence (Crude Or Cumulative Rate)Risk FactorsRemarks/Treatment ModalityT.…”

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

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<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Hasegawa¹,

Yamamoto

Shin³

et al. 2019

TCRM

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Gamma Knife radiosurgery (GKRS) has long been used for treating brain vascular malformations, including arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), and cavernous malformations (CMs). Herein, current evidence and controversies regarding the role of stereotactic radiosurgery for vascular malformations are described. 1) It has already been established that GKRS achieves 70–85% obliteration rates after a 3–5-year latency period for small to medium-sized AVMs. However, late radiation-induced adverse events (RAEs) including cyst formation, encapsulated hematoma, and tumorigenesis have recently been recognized, and the associated risks, clinical courses, and outcomes are under investigation. SRS-based therapeutic strategies for relatively large AVMs, including staged GKRS and a combination of GKRS and embolization, continue to be developed, though their advantages and disadvantages warrant further investigation. The role of GKRS in managing unruptured AVMs remains controversial since a prospective trial showed no benefit of treatment, necessitating further consideration of this issue. 2) Regarding DAVFs, GKRS achieves 41–90% obliteration rates at the second post-GKRS year with a hemorrhage rate below 5%. Debate continues as to whether GKRS might serve as a first-line solo therapeutic modality given its latency period. Although the post-GKRS outcomes are thought to differ among lesion locations, further outcome analyses regarding DAVF locations are required. 3) GKRS is generally accepted as an alternative for small or medium-sized CMs in which surgery is considered to be too risky. The reported hemorrhage rates ranged from 0.5–5% after GKRS. Higher dose treatments (>15 Gy) were performed during the learning curve, while, with the current standard treatment, a dose range of 12–15 Gy is generally selected, and has resulted in acceptable complication rates (< 5%). Nevertheless, further elucidation of long-term outcomes is essential.

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Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

See 3 more Smart Citations

<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Hasegawa¹,

Yamamoto

Shin³

et al. 2019

TCRM

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Radiation-induced malignancies after stereotactic radiosurgery for brain arteriovenous malformations: a large single-center retrospective study and systematic review

Hirata,

Umekawa,

Shinya

et al. 2024

Neurosurg Rev

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Stereotactic radiosurgery (SRS) is widely utilized to treat small- and medium-sized brain arteriovenous malformations (BAVMs); however, radiation-induced malignancies (RIMs) have been reported as extremely rare yet potentially life-threatening complications of SRS. This study aimed to investigate the risk of RIMs after SRS for BAVMs. The outcomes of patients who underwent single-session SRS for BAVMs at our institution and were followed for ≥ 5 years were analyzed to calculate the incidence of RIMs. In addition, a systematic review was conducted using the existing literature reporting RIMs after SRS for BAVMs in compliance with the PRISMA guideline. Regarding the in-hospital analysis, only one (0.18%) RIM (gliosarcoma) was observed among 569 patients, with a median follow-up period of 151 months (interquartile range, 103–255 months). The 15, 20, and 25-year cumulative incidences of RIMs were 0%, 0%, and 1.01%, respectively, whereas the overall incidence rate was 0.12 per 1,000 patient-years. In the systematic review, 14 studies were included, with the incidence of RIMs ranging from 0.00 to 0.24%. Eight patients with RIMs were identified, and the most common pathology was glioblastoma. The median time until the diagnosis of RIM was 7.1 years (range, 4–19 years) after SRS, and their clinical courses were largely dismal, with the post-diagnosis survival periods being 1–10 months. RIM constitutes an extremely rare but potentially fatal complication following SRS for BAVMs, with its incidence rate being at most 0.24%.

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Intracranial arteriovenous malformations

Ganz¹

2022

Progress in Brain Research

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A Comprehensive Study of Symptomatic Late Radiation-Induced Complications After Radiosurgery for Brain Arteriovenous Malformation: Incidence, Risk Factors, and Clinical Outcomes

Cited by 15 publications

References 43 publications

<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Radiation-induced malignancies after stereotactic radiosurgery for brain arteriovenous malformations: a large single-center retrospective study and systematic review

Intracranial arteriovenous malformations

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