Gamma knife radiosurgery for arteriovenous malformations: general principles and preliminary results in a Swiss cohort

Raboud, Matthieu; Tuleasca, Constantin; Maeder, Philippe; Schiappacasse, Luis; Marguet, Maud; Daniel, Roy Thomas; Levivier, Marc

doi:10.4414/smw.2018.14602

Cited by 6 publications

(6 citation statements)

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“…In the case of a hemorrhagic event consensus can be easily reached to promote the earliest possible treatment of the vascular nidus, thus reducing the subsequent risk of new bleeding. Classical treatment options might include microsurgical resection 7 , endovascular approach 8,9 or stereotactic radiosurgery [10][11][12] . These treatment modalities can be performed stand-alone or combined, depending on the AVM architecture and the post-therapeutic evolution.…”

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confidence: 99%

Radiosurgery for unruptured brain arteriovenous malformations in the pre-ARUBA era: long-term obliteration rate, risk of hemorrhage and functional outcomes

Peciu-Florianu

Leroy

Drumez³

et al. 2020

Sci Rep

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The management of non-hemorrhagic arteriovenous malformations (AVMs) remains a subject of debate, even more since the ARUBA trial. Here, we report the obliteration rate, the risk of hemorrhage and the functional outcomes after Gamma Knife radiosurgery (GKRS) as first-line treatment for non-hemorrhagic AVMs treated before the ARUBA publication, in a reference university center with multimodal AVM treatments available. We retrospectively analyzed data from a continuous series of 172 patients harboring unruptured AVMs treated by GKRS as first-line treatment in our Lille University Hospital, France, between April 2004 and December 2013. The primary outcome was obliteration rate. Secondary outcomes were the hemorrhage rate, the modified Rankin Scale (mRS), morbidity and epilepsy control at last follow-up. The minimal follow-up period was of 3 years. Median age at presentation was 40 years (IQR 28; 51). Median follow-up was 8.8 years (IQR 6.8; 11.3). Median target volume was 1.9 cm3 (IQR 0.8–3.3 cm3), median Spetzler-Martin grade: 2 (IQR 1–2), median Pollock-Flickinger score: 1.07 (IQR 0.82–2.94), median Virginia score: 1 (IQR 1–2). Median treatment dose was 24 Gy at 50% isodose line. Twenty-three patients underwent a second GKRS after a median time of 58 months after first GKRS. The overall obliteration rate was of 76%, based primarily on cerebral angiography and/or rarely only upon MRI. Hemorrhage during the post-treatment follow-up was reported in 18 (10%) patients (annual risk of 1.1%). Transient post-GKRS morbidity was reported in 14 cases (8%) and persistent neurological deficit in 8 (4.6%) of patients. At last follow-up, 86% of patients had a mRS ≤ 1. Concerning patients with pretherapeutic epilepsy, 84.6% of them were seizure-free at last follow-up. GKRS as first-line therapeutic option for unruptured cerebral AVMs achieves high obliteration rates (76%) while maintaining a high-level patient’s autonomy. All hemorrhagic events occurred during the first 4 years after the initial GKRS. In cases with epilepsy, there was 84.6% seizure free at last follow-up. Permanent morbidity was reported in only 4.6%.

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confidence: 99%

Radiosurgery for unruptured brain arteriovenous malformations in the pre-ARUBA era: long-term obliteration rate, risk of hemorrhage and functional outcomes

Peciu-Florianu

Leroy

Drumez³

et al. 2020

Sci Rep

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“…Thirty-three (97%) studies were from single centres and one (3%) was multi-centre (Appendix 7 ). Thirteen (39%) studies were from North America [ 4 , 14 – 16 , 18 , 41 , 43 – 45 , 52 , 56 , 66 , 74 ], 12 (36%) from Asia [ 5 , 6 , 8 , 31 , 32 , 36 , 39 , 46 , 47 , 51 , 57 , 75 ] and 8 (24%) from Europe [ 2 , 24 , 35 , 49 , 54 , 58 , 65 , 71 ].…”

Section: Resultsmentioning

confidence: 99%

“…All four studies had > 80% of total patients treated available for analysis at the end of follow-up. All studies were retrospective, except one which identified and followed consecutive patients prospectively (Appendix 7 ) [ 65 ]. Three studies (9%) were deemed moderate risk of reporting bias [ 6 , 8 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…Complete nidus obliteration, confirmed on angiography imaging, was achieved in 56.7% (3092/5450) of patients in 21 cohorts, at the end of follow-up after single-stage Gamma knife treatment [ 5 – 8 , 14 – 16 , 24 , 31 , 32 , 36 , 39 , 46 , 47 , 49 , 51 , 52 , 54 , 57 , 58 , 65 ]. Overall nidus obliteration, confirmed with either angiography or MRI imaging, was achieved in 67.8% (4605/6792) of patients in 29 cohorts, at the end of follow-up after single-stage Gamma knife treatment [ 2 , 4 – 8 , 14 – 16 , 18 , 24 , 31 , 32 , 36 , 39 , 46 , 47 , 51 , 52 , 54 , 56 – 58 , 64 , 65 , 71 , 74 , 75 ]. Table 3 outlines AVM GKRS obliteration outcomes.…”

Section: Resultsmentioning

confidence: 99%

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Gamma Knife radiosurgery for cerebral arteriovenous malformations: a systematic review and meta-analysis

et al. 2022

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Materials and methods Registration and reporting standardsWe performed this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Appendix 1) [53]. The study protocol is published on PROSPERO (CRD 42,021,285,118). Search strategyWe performed a comprehensive literature search (Appendix 2) using OVID Medline, EMBASE, ClinicalTrials.gov, OpenGrey and Cochrane Library from 1st January 1989 to 1st September 2021 for relevant articles. We reviewed the bibliographies of included studies for further articles meeting our eligibility criteria. Eligibility criteriaWe sought randomised trials and observational cohort studies, published in English in peer-reviewed journals reporting 20 + adult (18 +) patients with AVMs, diagnosed by MRI or histopathological examination, treated with single-session GKRS. We included studies describing all the following patient and AVM characteristics: (1) median (or mean) margin dose, (2) AVM volume (or maximum nidus diameter), (3) clinical presentation, (4) AVM Spetzler-Martin grades. We included studies reporting all the following clinical and radiological outcomes, with a minimum follow-up period of 12 months following GKRS: (1) complete nidus obliteration rate (angiography or angiography/MRI-confirmed), (2) post-GKRS ICH, (3) RICs or adverse radiation effects (ARE).

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“…Para las MAVs más pequeñas, varios estudios han sugerido que la embolización previa es un factor predictivo negativo de la obliteración por SRS (14,31). Sin embargo, la reducción del tamaño por embolización aumentó la tasa de obliteración en las grandes MAV según lo informado por Veznedaroglu y colaboradores (32).…”

Section: Tratamiento Multimodalunclassified

Papel de la radiocirugía en el tratamiento de malformaciones arterio-venosas cerebrales : revisión de la literatura y análisis de resultados.

et al. 2021

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Introducción: las malformaciones arteriovenosas (MAVs) son patologías infrecuentes, con una incidencia estimada de 1,1 en 100.000 habitantes. El tratamiento puede ser embolización vascular, microcirugía o radiocirugía estereotáctica. Por su baja incidencia, resulta difícil seleccionar un grupo homogéneo para un seguimiento prospectivo a largo plazo, y en base a resultados estadísticamente significativos definir una conducta. Objetivo: establecer el rol de la radiocirugía estereotáctica en el tratamiento de malformaciones arteriovenosas cerebrales. Métodos: se realizó una búsqueda en bases de datos para un análisis descriptivo de ensayos clínicos en pacientes con malformaciones arteriovenosas tratados con radiocirugía estereotáctica, sin radioterapia previa. Resultados: fueron seleccionados 26 artículos. Los resultados provenientes en su mayoría de estudios retrospectivos. La obliteración estimada para malformaciones arteriovenosas pequeñas o moderadas con radiocirugía estereotáctica varía entre un 61% a 90%, con una morbilidad menor a 5%. La respuesta al tratamiento varía según el tamaño del nido, la dosis y la no embolización previa. Para las malformaciones arteriovenosas gigantes la tasa de obliteración descrita es del 35% al 58%, con una morbilidad que alcanza el 15%. Conclusión: la radiocirugía estereotáctica parece ser una opción efectiva y segura cuando no se plantea microcirugía, con tasas satisfactorias de obliteración, sin aumento del riesgo de sangrado en el periodo de latencia. En malformaciones arteriovenosas gigantes la radiocirugía muestra una menor tasa de respuesta completa por lo que el tratamiento intervencionista multimodal es justificable. La radiocirugía estereotáctica ha demostrado ser segura y efectiva, con un papel preponderante en malformaciones arteriovenosas pequeñas, profundas o en áreas elocuentes.

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Gamma knife radiosurgery for arteriovenous malformations: general principles and preliminary results in a Swiss cohort

Cited by 6 publications

References 33 publications

Radiosurgery for unruptured brain arteriovenous malformations in the pre-ARUBA era: long-term obliteration rate, risk of hemorrhage and functional outcomes

Radiosurgery for unruptured brain arteriovenous malformations in the pre-ARUBA era: long-term obliteration rate, risk of hemorrhage and functional outcomes

Gamma Knife radiosurgery for cerebral arteriovenous malformations: a systematic review and meta-analysis

Papel de la radiocirugía en el tratamiento de malformaciones arterio-venosas cerebrales : revisión de la literatura y análisis de resultados.

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