Linac-based Stereotactic Radiosurgery for Brain Arteriovenous Malformations

Blamek, Sławomir; Tarnawski, Rafał; Miszczyk, Leszek

doi:10.1016/j.clon.2011.03.012

Cited by 25 publications

(15 citation statements)

References 39 publications

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“…In a previous study reported by Blamek et al [10], the outcome after radiosurgical treatment for low-grade AVMs was significantly better than that for high-grade lesions, and the result was consistent with other reports [26,27,28]. Koltz et al [11] reported a study in 2013 which indicated that there will be a better response and fewer complications if the Spetzler-Martin grade is III or less.…”

Section: Discussionsupporting

confidence: 80%

“…Kasliwal et al [20] found that the rate of obliteration was higher in AVMs less than 3 cm 3 (72%) as compared to AVMs larger than 3 cm 3 (61%). As to LINAC SRS, it has been reported that AVM nidus diameter <3 cm significantly influences the probability of obliteration [10,19]. In our series, the volume of 5 cm 3 was the boundary.…”

Section: Discussionmentioning

confidence: 70%

“…SRS, including LINAC-based and gamma knife systems, has been shown in previous studies to be an effective treatment for AVMs [10,22,23]. It is typically recommended for AVMs that are small (<2-3 cm in diameter), unruptured, and surgically inaccessible [9,24].…”

Section: Discussionmentioning

confidence: 99%

“…AVM obliteration rates reported in the previous literature generally range between 60 and 80% [10,11]. There are several factors that have been described, mostly including peripheral dose, AVM volume, and embolization status [12,13,14,15,16,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

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Linear Accelerator Stereotactic Radiosurgery in the Management of Intracranial Arteriovenous Malformations: Long-Term Outcome

Wang

Huang²,

Chen³

et al. 2014

Cerebrovasc Dis

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Background: Arteriovenous malformation (AVM) is one of the cerebrovascular diseases that bear a high risk of hemorrhage. The treatment modalities include microsurgical resection, endovascular embolization, stereotactic radiosurgery, or combinations that vary widely. Several large series have been reported, while data from Asian populations were few. The aim of this study was to examine the efficacy of linear accelerator stereotactic radiosurgery (LINAC SRS) for the treatment of intracranial AVMs, to evaluate the hemorrhage rate and to analyze associated factors. Methods: One hundred and sixteen patients with AVM were treated with LINAC SRS in a single institute between September 1994 and May 2005 and were retrospectively evaluated. The demographics of patients, clinical characteristics of AVM, the treatment modalities, and the parameters of the LINAC SRS were analyzed. Delayed toxicity and hemorrhage rate after treatment were also evaluated. The AVM obliteration and bleed rates were calculated using the Kaplan-Meier method and Cox regression analyses. Results: The efficacy rate with total obliteration after treatment was 81.9% (95 of 116 patients). The median interval to achieve total obliteration was 49 months. Microsurgical resection combined with SRS for residual AVMs achieved better obliteration rates compared to SRS alone (statistically significant, p = 0.001), while no significant difference was found between the embolization group and the group with no prior treatment (p = 0.895). The Spetzler-Martin grade of AVM is a relative factor of obliteration, higher grades resulting in a worse outcome (p = 0.009). Obliteration was significantly influenced by AVM volume in univariate analysis (p = 0.034), and volume <5 cm³ contributed to improved obliteration (p = 0.01). There was no statistically significant difference in the hemorrhagic rate and the complication rate between ruptured and unruptured AVMs, while the unruptured group had a higher obliteration rate (p = 0.024). The annual hemorrhage rate after LINAC SRS treatment was 1.9%. The bleeding rate was 3.3% in the first year after radiosurgery, 2.1% in the second year, 1.9% between the second and fifth year, and 1.5% between the fifth and tenth year. Patients with hemorrhagic events before radiosurgery appeared to have a higher rebleeding risk during the latency period. Twenty-three patients (19.8%) had late adverse effects with regard to posttreatment radiological follow-up, but only 1 (0.8%) had newly developed neurological deficits. Conclusion: LINAC SRS achieved a high obliteration rate and reduced the risk of hemorrhage effectively in ruptured and unruptured intracranial AVMs. Prior microsurgical resection provided better outcome, while embolization showed no benefit. Adverse effects after treatment are acceptable and require long-term follow-up.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Linear Accelerator Stereotactic Radiosurgery in the Management of Intracranial Arteriovenous Malformations: Long-Term Outcome

Wang

Huang²,

Chen³

et al. 2014

Cerebrovasc Dis

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“…Although most studies present results of gamma-knife treatment dealing with radiosurgery for cerebral arteriovenous malformations, linear accelerated based radiosurgery is becoming increasingly popular. Much uncertainty still exists about the rationale of combined endovascular and radiosurgical treatment [7]. Stereotactic radiosurgery uses a single fraction high dose radiation while stereotactic radiotherapy uses multifractionated lower dose focused radiation.…”

Section: Introductionmentioning

confidence: 99%

LINAC Stereotactic Radiosurgery for brain arteriovenous malformation: a single institutional experience from Saudi Arabia

Fareed¹,

Amro²,

Bayoumi³

et al. 2013

Neurosci Discov

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Background: Linear accelerator (LINAC) based radiosurgery for a brain arteriovenous malformation (bAVM) is replacing gamma knife radiosurgery. We present clinical outcome, obliteration rates and predictor factors of treatment success following LINAC radiosurgery for bAVM which is not much addressed subject in Middle East. Methods: 13 patients who underwent LINAC radiosurgery for brain arteriovenous malformations from November 2008 to November 2011 in our radiation oncology department were retrospectively analyzed. Recollection of demographic data, AVM and treatment characteristics along with clinical and radiographic follow up information was done by reviewing the electronic data base. Results: All thirteen patients underwent stereotactic radiosurgery by linear accelerator based treatment delivery system (BrainLab) over three years. These included 7 males and 6 females, with median age of 22 years. Intracranial hemorrhage was a presenting feature in 7 (54 %) of patients. Prior embolization was done in 10 (77%) patients with 7 patients having more than once undergone this procedure. The location of AVM was superficial in 9 (70%) and deep in brain in 4 (30%) patients. The mean AVM score was 0.97 with 3 patients having AVM score ≥ 1 with mean Spetzler-Martin grade of 2.7 and 8 (62%) patients having grade 3 or more. Median follow up was 30 months. Mean dose delivered was 21.7 Gy in single fraction. Complete obliteration of AVM nidus was achieved in 9 (70%) patients while 4 patients (30%) had partial obliteration. Six patients (67 %) achieved complete obliteration among 9 who had AVM score of less than 1. Post radiosurgery neurological deficit occurred in only one patient in form of right temporal field loss. Conclusions: Linear accelerator based radiosurgery is promising treatment option for brain AVMs in majority of cases with reasonable adverse effect profile.

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Neurological Outcome and Efficacy of AVM Treatment

Bradáč

Beneš

2017

Brain Arteriovenous Malformations

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Linac-based Stereotactic Radiosurgery for Brain Arteriovenous Malformations

Cited by 25 publications

References 39 publications

Linear Accelerator Stereotactic Radiosurgery in the Management of Intracranial Arteriovenous Malformations: Long-Term Outcome

Linear Accelerator Stereotactic Radiosurgery in the Management of Intracranial Arteriovenous Malformations: Long-Term Outcome

LINAC Stereotactic Radiosurgery for brain arteriovenous malformation: a single institutional experience from Saudi Arabia

Neurological Outcome and Efficacy of AVM Treatment

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