Stereotactic Radiosurgery for Brain Arteriovenous Malformations: Evaluation of Obliteration and Review of Associated Predictors

Daou, Badih; Palmateer, Gregory; Thompson, B. Gregory; Maher, Cormac O.; Hayman, James A.; Lam, Kwok L.; Wahl, Daniel R.; Kim, Michelle; Pandey, Aditya S.

doi:10.1016/j.jstrokecerebrovasdis.2020.104863

Cited by 34 publications

(24 citation statements)

References 49 publications

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“…In the case of AVMs treated with a margin dose of 17–18 Gy or more, there was a nearly three‐fold increased likelihood of obliteration. An inverse correlation between AVM volume and prescribed dose existed 1 . Smaller AVMs allow higher doses of radiation to be employed safely.…”

Section: Discussionmentioning

confidence: 95%

“…An inverse correlation between AVM volume and prescribed dose existed. 1 Smaller AVMs allow higher doses of radiation to be employed safely. Another study by Ding et al 32 demonstrated that AVM cases with nidus volume >4 cc treated with a margin dose of ≥18 Gy reaped more favourable outcomes (76.3%), compared with those with volume ≤4 cc or those treated with <18 Gy (51.1%, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion criteria were defined as follows: (1) studies reporting more than 20 cases diagnosed as brain AVMs and each enrolled subject should be represented only once; (2) articles reporting variables associated with nidus obliteration after SRS under univariate or multivariate analysis using Cox proportional hazards models; (3) randomized controlled trials (RCT), cohort studies, case-control studies, or case series; (4) full-text papers written in English. Studies were considered ineligible if they involved overlapping published data from the same institution or the same research foundation.…”

Section: Selection Criteria and Quality Assessmentmentioning

confidence: 99%

“…Brain arteriovenous malformations (AVMs) are congenital anomalies of the blood vessels that stem from the lack of an intervening capillary bed, allowing direct transition between cerebral arteries and veins, with an estimated incidence of 1.12-1.34 per 100 000 person-years. 1,2 Typical management options for patients with AVMs consist of surgical resection, endovascular embolization, and stereotactic radiosurgery (SRS). Among them, SRS has evolved over the years since the first report of successful radiosurgery in 1972, 3 and it is currently considered an established modality for the non-open surgical treatment of cerebral AVMs.…”

Section: Introductionmentioning

confidence: 99%

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The factors associated with obliteration following stereotactic radiosurgery in patients with brain arteriovenous malformations: a meta‐analysis

Wang

et al. 2021

ANZ Journal of Surgery

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Background: Various factors have been reported to affect the obliteration of brain arteriovenous malformations (AVM) following stereotactic radiosurgery (SRS). This meta-analysis was conducted to identify the factors potentially associated with AVM obliteration after SRS. Methods: We comprehensively searched databases and included studies that evaluated predictors of AVM obliteration after SRS using Cox proportional hazard regression analysis. Hazard ratios (HRs) with 95% confidence intervals (CIs) were utilized as effect estimates. Results: Twelve studies, involving 4415 AVM cases, were included. According to combined estimates on univariate (UV) and multivariate (MV) analysis, age, gender and prior haemorrhage did not affect the closure probability. The following factors showed a significant and independent association with increased AVM obliteration: smaller AVMs maximal diameter (MV, HR: 1.32), smaller AVM volume (MV, HR: 1.05), AVM volume <10-15 cc (MV, HR: 1.55), higher margin dose (MV, HR: 1.05), margin dose ≥17-18 Gy (MV, HR: 3.71) and early treatment period (MV, HR: 1.78). Previous embolization and deep-seated AVM were independently negative predictors of obliteration whereas deep venous drainage was a positive predictor. Prior surgery, compactness of nidus, lower grading scores and higher SRS maximum dose were associated factors subject to confounding factors. Conclusion: Multiple factors associated with obliteration should be taken into consideration for selection of candidates with AVMs for SRS. AVM volume and radiation dose are the most prominent factor in assessing obliteration after SRS. Age, gender and prior haemorrhage may not affect the consideration of SRS treatment. Cautious use of SRS is needed for previously embolized AVM patients. * Two sets of data were extracted for presentation, namely data for AVMs treated by GK alone (81 patients) and data for AVMs with post-GK embolization (17 patients). † Two sets of data in different treatment periods were extracted.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Selection Criteria and Quality Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The factors associated with obliteration following stereotactic radiosurgery in patients with brain arteriovenous malformations: a meta‐analysis

Wang

et al. 2021

ANZ Journal of Surgery

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“…Stereotactic radiosurgery (SRS) has become one standard treatment strategy of brain arteriovenous malformation (bAVM), especially those located in deep or eloquent regions with high surgical risks, and mounting studies suggested that SRS can achieve a satisfactory obliteration rate ( 1 ). Younger age, male gender, small size, small target volume, higher radiation dose, and a lone major draining vein have been found to be associated with obliteration after SRS for bAVMs ( 2 ). Partial embolization was generally used to reduce the volume of large bAVMs to facilitate the complete obliteration after the following SRS ( 3 ), and the targeted embolization for the comorbid aneurysms and arteriovenous fistulas may be beneficial in reducing the rupture risk after SRS ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Radiosurgery With vs. Without Prior Embolization for Brain Arteriovenous Malformations: A Propensity Score Matching Analysis

Yan

Chen

et al. 2021

Front. Neurol.

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Objective: Whether partial embolization could facilitate the post-stereotactic radiosurgery (SRS) obliteration for brain arteriovenous malformations (bAVMs) remains controversial. We performed this study to compare the outcomes of SRS with and without prior embolization for bAVMs.Methods: We retrospectively reviewed the Beijing Tiantan AVMs prospective registration research database from September 2011 to October 2014. Patients were categorized into two groups, combined upfront embolization and SRS (Em+SRS group) and SRS alone (SRS group), and we performed a propensity score matching analysis based on pre-embolization baseline characteristics; the matched groups each comprised 76 patients.Results: The obliteration rate was similar between SRS and Em+SRS (44.7 vs. 31.6%; OR, 1.754; 95% CI, 0.905–3.401; p = 0.096). However, the SRS group was superior to the Em+SRS group in terms of cumulative obliteration rate at a follow-up of 5 years (HR,1.778; 95% CI, 1.017–3.110; p = 0.033). The secondary outcomes, including functional state, post-SRS hemorrhage, all-cause mortality, and edema or cyst formation were similar between the matched cohorts. In the ruptured subgroup, the SRS group could achieve higher obliteration rate than Em+SRS group (56.5 vs. 31.9%; OR, 2.773; 95% CI, 1.190–6.464; p = 0.018). The cumulative obliteration rate at 5 years was also higher in the SRS group (64.5 vs. 41.3%; HR, 2.012; 95% CI, 1.037–3.903; p = 0.038), and the secondary outcomes were also similar between the matched cohorts.Conclusion: Although there was no significant difference in the overall obliteration rate between the two strategies, this study suggested that pre-SRS embolization may have a negative effect on post-SRS obliteration. Furthermore, the obliteration rates of the SRS only strategy was significantly higher than that of the Em+SRS strategy in the ruptured cohort, while no such phenomenon was found in the unruptured cohort.

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Deep Learning Detection and Segmentation of Brain Arteriovenous Malformation on Magnetic Resonance Angiography

Hong

You

Sun

et al. 2023

Magnetic Resonance Imaging

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BackgroundThe delineation of brain arteriovenous malformations (bAVMs) is crucial for subsequent treatment planning. Manual segmentation is time‐consuming and labor‐intensive. Applying deep learning to automatically detect and segment bAVM might help to improve clinical practice efficiency.PurposeTo develop an approach for detecting bAVM and segmenting its nidus on Time‐of‐flight magnetic resonance angiography using deep learning methods.Study TypeRetrospective.Subjects221 bAVM patients aged 7–79 underwent radiosurgery from 2003 to 2020. They were split into 177 training, 22 validation, and 22 test data.Field Strength/Sequence1.5 T, Time‐of‐flight magnetic resonance angiography based on 3D gradient echo.AssessmentThe YOLOv5 and YOLOv8 algorithms were utilized to detect bAVM lesions and the U‐Net and U‐Net++ models to segment the nidus from the bounding boxes. The mean average precision, F1, precision, and recall were used to assess the model performance on the bAVM detection. To evaluate the model's performance on nidus segmentation, the Dice coefficient and balanced average Hausdorff distance (rbAHD) were employed.Statistical TestsThe Student's t‐test was used to test the cross‐validation results (P < 0.05). The Wilcoxon rank test was applied to compare the median for the reference values and the model inference results (P < 0.05).ResultsThe detection results demonstrated that the model with pretraining and augmentation performed optimally. The U‐Net++ with random dilation mechanism resulted in higher Dice and lower rbAHD, compared to that without that mechanism, across varying dilated bounding box conditions (P < 0.05). When combining detection and segmentation, the Dice and rbAHD were statistically different from the references calculated using the detected bounding boxes (P < 0.05). For the detected lesions in the test dataset, it showed the highest Dice of 0.82 and the lowest rbAHD of 5.3%.Data ConclusionThis study showed that pretraining and data augmentation improved YOLO detection performance. Properly limiting lesion ranges allows for adequate bAVM segmentation.Level of Evidence4Technical Efficacy Stage1

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Stereotactic Radiosurgery for Brain Arteriovenous Malformations: Evaluation of Obliteration and Review of Associated Predictors

Cited by 34 publications

References 49 publications

The factors associated with obliteration following stereotactic radiosurgery in patients with brain arteriovenous malformations: a meta‐analysis

The factors associated with obliteration following stereotactic radiosurgery in patients with brain arteriovenous malformations: a meta‐analysis

Stereotactic Radiosurgery With vs. Without Prior Embolization for Brain Arteriovenous Malformations: A Propensity Score Matching Analysis

Deep Learning Detection and Segmentation of Brain Arteriovenous Malformation on Magnetic Resonance Angiography

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