Seizure Outcome in Children Treated for Arteriovenous Malformations Using Gamma Knife Radiosurgery

Gerszten, Peter C.; Adelson, P. David; Kondziolka, Douglas; Flíckinger, John C.; Lunsford, L.D.

doi:10.1159/000121030

Cited by 87 publications

(296 citation statements)

References 27 publications

Supporting

Mentioning

288

Contrasting

Unclassified

Order By: Relevance

“…This finding might be a reflection of the relatively small sample size and larger AVM volumes. Although others have noted that AVM obliteration is not required to improve seizure outcomes, 7,11 prior reports have indicated that seizure reduction is more frequent among those for whom AVM obliteration is acheived. 3,12,34,42,44 Our data also indicate that a history of prior hemorrhage is a negative prognostic factor for seizure improvement.…”

Section: 182728mentioning

confidence: 99%

See 1 more Smart Citation

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Bowden

Kano

Tonetti

et al. 2014

JNS

View full text Add to dashboard Cite

Object Sylvian fissure arteriovenous malformations (AVMs) present substantial management challenges because of the critical adjacent blood vessels and functional brain. The authors investigated the outcomes, especially hemorrhage and seizure activity, after stereotactic radiosurgery (SRS) of AVMs within or adjacent to the sylvian fissure. Methods This retrospective single-institution analysis examined the authors' experiences with Gamma Knife surgery for AVMs of the sylvian fissure in cases treated from 1987 through 2009. During this time, 87 patients underwent SRS for AVMs in the region of the sylvian fissure. Before undergoing SRS, 40 (46%) of these patients had experienced hemorrhage and 36 (41%) had had seizures. The median target volume of the AVM was 3.85 cm3 (range 0.1–17.7 cm3), and the median marginal dose of radiation was 20 Gy (range 13–25 Gy). Results Over a median follow-up period of 64 months (range 3–275 months), AVM obliteration was confirmed by MRI or angiography for 43 patients. The actuarial rates of confirmation of total obliteration were 35% at 3 years, 60% at 4 and 5 years, and 76% at 10 years. Of the 36 patients who had experienced seizures before SRS, 19 (53%) achieved outcomes of Engel class I after treatment. The rate of seizure improvement was 29% at 3 years, 36% at 5 years, 50% at 10 years, and 60% at 15 years. No seizures developed after SRS in patients who had been seizure free before treatment. The actuarial rate of AVM hemorrhage after SRS was 5% at 1, 5, and 10 years. This rate equated to an annual hemorrhage rate during the latency interval of 1%; no hemorrhages occurred after confirmed obliteration. No permanent neurological deficits developed as an adverse effect of radiation; however, delayed cyst formation occurred in 3 patients. Conclusions Stereotactic radiosurgery was an effective treatment for AVMs within the region of the sylvian fissure, particularly for smaller-volume AVMs. After SRS, a low rate of hemorrhage and improved seizure control were also evident.

show abstract

Section: 182728mentioning

confidence: 99%

“…1,14 Rates of seizure elimination after SRS for cortical AVMs, regardless of location, range from 50% to 85%. 1,11,23,24 Seizure-free outcomes according to treatment modalities are 78% after microsurgery, 63% after radiosurgery, and 50% after embolization.…”

Section: Factors Associated With Seizuresmentioning

confidence: 99%

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Bowden

Kano

Tonetti

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…For the final quantitative analysis, we identified 19 series comprising 1104 patients with AVMs and seizures who underwent SRS. 2,13,16,20,22,33,34,37,39,41,43,48,57,58,63,64,69,71,73 Figure 1 shows a flow chart of the review process.…”

Section: Literature Searchmentioning

confidence: 99%

“…33,41,69,71 However, this association was found to be nonsignificant in 4 other studies. 22,37,39,57 Relationships between seizure characteristics and seizure outcomes following SRS were also inconsistent; complex partial seizures with or without secondary generalization, generalized tonic-clonic seizures, infrequent and shortduration seizures, and seizure frequency have been associated with improved seizure control. 16,33,39,57,71 In contrast, other studies have also found no significant relationship between seizure outcome and seizure type, duration, frequency, and pattern or age at seizure onset.…”

Section: Obliteration and Other Factors Related To Seizure Outcomementioning

confidence: 99%

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

Chen

Chivukula

Ding

et al. 2014

FOC

View full text Add to dashboard Cite

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.

show abstract

“…29 Another AVM radiosurgery study of 15 pediatric patients with seizures at presentation did not find obliteration to be associated with seizure outcomes. 22 Additionally, Schauble et al reported on a series of 65 patients with AVM-associated seizures who underwent radiosurgery without a significant association between obliteration and seizure control. 42 Engel Class I outcomes were observed in 78% of patients.…”

Section: Effect Of Radiosurgery On Seizures Outcomes For Patients Witmentioning

confidence: 99%

Radiosurgery for temporal lobe arteriovenous malformations: effect of temporal location on seizure outcomes

Ding¹,

Quigg

Starke³

et al. 2015

JNS

View full text Add to dashboard Cite

T reaTmenT of temporal lobe arteriovenous malformations (AVMs) carries burdens beyond the primary consideration of prevention of hemorrhage. Prior studies of AVM-associated epilepsy have shown that higher rates of epilepsy are associated with temporal lobe involvement. 20,23,24,48 Interventional therapy has the potential to control AVM-associated epilepsy.2,23 Since posttreatment epilepsy status has a strong influence on quality of life and functional outcomes, treatment-induced seizure control is an important consideration. 25Thus, the success of an intervention is dictated by more than obliteration of the AVM nidus. Radiosurgery is a minimally invasive treatment alternative to microsurgery for AVMs and induces gradual obliteration of the nidus over aBBreViatiONS AED = antiepileptic drug; AVM = arteriovenous malformation; MTLE = mesial temporal lobe epilepsy; RBAS = radiosurgery-based AVM score; RIC = radiation-induced change; VRAS = Virginia Radiosurgery AVM Scale. OBJect The temporal lobe is particularly susceptible to epileptogenesis. However, the routine use of anticonvulsant therapy is not implemented in temporal lobe AVM patients without seizures at presentation. The goals of this case-control study were to determine the radiosurgical outcomes for temporal lobe AVMs and to define the effect of temporal lobe location on postradiosurgery AVM seizure outcomes. methOdS From a database of approximately 1400 patients, the authors generated a case cohort from patients with temporal lobe AVMs with at least 2 years follow-up or obliteration. A control cohort with similar baseline AVM characteristics was generated, blinded to outcome, from patients with non-temporal, cortical AVMs. They evaluated the rates and predictors of seizure freedom or decreased seizure frequency in patients with seizures or de novo seizures in those without seizures. reSultS A total of 175 temporal lobe AVMs were identified based on the inclusion criteria. Seizure was the presenting symptom in 38% of patients. The median AVM volume was 3.3 cm 3 , and the Spetzler-Martin grade was III or higher in 39% of cases. The median radiosurgical prescription dose was 22 Gy. At a median clinical follow-up of 73 months, the rates of seizure control and de novo seizures were 62% and 2%, respectively. Prior embolization (p = 0.023) and lower radiosurgical dose (p = 0.027) were significant predictors of seizure control. Neither temporal lobe location (p = 0.187) nor obliteration (p = 0.522) affected seizure outcomes. The cumulative obliteration rate was 63%, which was significantly higher in patients without seizures at presentation (p = 0.046). The rates of symptomatic and permanent radiationinduced changes were 3% and 1%, respectively. The annual risk of postradiosurgery hemorrhage was 1.3%. cONcluSiONS Radiosurgery is an effective treatment for temporal lobe AVMs. Furthermore, radiosurgery is protective against seizure progression in patients with temporal lobe AVM-associated seizures. Temporal lobe location does not affect radiosurgery-induced seizure...

show abstract

Seizure Outcome in Children Treated for Arteriovenous Malformations Using Gamma Knife Radiosurgery

Cited by 87 publications

References 27 publications

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

Radiosurgery for temporal lobe arteriovenous malformations: effect of temporal location on seizure outcomes

Contact Info

Product

Resources

About