Stereotactic Radiosurgery in Intracranial Arterio-Venous Malformations

Steiner, Ladislau; Leksell, L; Förster, David; Greitz, T.; Backlund, Erik‐Olof

doi:10.1007/978-3-7091-8355-7_26

Cited by 75 publications

(53 citation statements)

References 7 publications

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“…38 The rate of obliteration proven either on angiography or MRI/MR angiography has been reported as 70%-86.5% in 5 years, depending on various factors. 10,16,20,39,40 Failure of obliteration is multifactorial and is related to dose, volume, inadequate recognition of the 3D geometry, recanalization of previously embolized components, or clotcompressed AVM that is subtotally treated. Studies from the University of Tokyo as well as reinterpretation of the outcome data from the Karolinska experience have suggested that there may be some protective benefit to AVMs even before complete obliteration of their nidus occurs.…”

Section: Discussionmentioning

confidence: 99%

“…Following radiosurgery, 80% of patients demonstrate obliteration on long-term follow-up. 3,5,11,15,19,20,23,[28][29][30][31][32]39,42,45 During the period following radiosurgery, adverse radiation effects (AREs) accompanied by changes on T2-abbreviatioNs ARE = adverse radiation effect; AVM = arteriovenous malformation; GKRS = Gamma Knife radiosurgery; SRS = stereotactic radiosurgery; VRAS = Virginia Radiosurgery AVM Scale. submitted September 30, 2014.…”

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confidence: 99%

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A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

Cohen-Inbar

Lee

et al. 2015

JNS

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OBJECT The authors review outcomes following Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVMs) and their correlation to postradiosurgery adverse radiation effects (AREs). METHODS From a prospective institutional review board–approved database, the authors identified patients with a minimum of 2 years of follow-up and thin-slice T2-weighted MRI sequences for volumetric analysis. A total of 105 AVM patients were included. The authors analyzed the incidence and quantitative changes in AREs as a function of time after GKRS. Statistical analysis was performed to identify factors related to ARE development and changes in the ARE index. RESULTS The median clinical follow-up was 53.8 months (range 24–212.4 months), and the median MRI follow-up was 36.8 months (range 24–212.4 months). 47.6% of patients had an AVM with a Spetzler-Martin grade ≥ III. The median administered margin and maximum doses were 22 and 40 Gy, respectively. The overall obliteration rate was 70.5%. Of patients who showed complete obliteration, 74.4% developed AREs within 4–6 months after GKRS. Late-onset AREs (i.e., > 12 months) correlated to a failure to obliterate the nidus. 58.1% of patients who developed appreciable AREs (defined as ARE index > 8) proceeded to have a complete nidus obliteration. Appreciable AREs were found to be influenced by AVM nidus volume > 3 ml, lobar location, number of draining veins and feeding arteries, prior embolization, and higher margin dose. On the other hand, a minimum ARE index > 8 predicted obliteration (p = 0.043). CONCLUSIONS ARE development after radiosurgery follows a temporal pattern peaking at 7–12 months after stereotactic radiosurgery. The ARE index serves as an important adjunct tool in patient follow-up and outcome prediction.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

Cohen-Inbar

Lee

et al. 2015

JNS

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“…On long-term follow-up, AVMs are obliterated in approximately 80% of patients who undergo radiosurgery. 6,7,10,13,15,16,19,[23][24][25]28,29,33,35,38 The results of radiosurgery, unlike those of microsurgery, may not fully manifest for many years after treatment. There is a risk of hemorrhage during the latency period between radiosurgery and obliteration, which may last up to 5 years.…”

Section: ©Aans 2013mentioning

confidence: 99%

A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients

Starke¹,

Yen²,

Ding³

et al. 2013

JNS

204

148

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Object. The authors performed a study to review outcomes following Gamma Knife radiosurgery for cerebral arteriovenous malformations (AVMs) and to create a practical scale to predict long-term outcome.Methods. Outcomes were reviewed in 1012 patients who were followed up for more than 2 years. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent, symptomatic, radiationinduced complication. Preradiosurgery patient and AVM characteristics predictive of outcome in multivariate analysis were weighted according to their odds ratios to create the Virginia Radiosurgery AVM Scale.Results. The mean follow-up time was 8 years (range 2-20 years). Arteriovenous malformation obliteration occurred in 69% of patients. Postradiosurgery hemorrhage occurred in 88 patients, for a yearly incidence of 1.14%. Radiation-induced changes occurred in 387 patients (38.2%), symptoms in 100 (9.9%), and permanent deficits in 21 (2.1%). Favorable outcome was achieved in 649 patients (64.1%). The Virginia Radiosurgery AVM Scale was created such that patients were assigned 1 point each for having an AVM volume of 2-4 cm 3 , eloquent AVM location, or a history of hemorrhage, and 2 points for having an AVM volume greater than 4 cm 3 . Eighty percent of patients who had a score of 0-1 points had a favorable outcome, as did 70% who had a score of 2 points and 45% who had a score of 3-4 points. The Virginia Radiosurgery AVM Scale was still predictive of outcome after controlling for predictive Gamma Knife radiosurgery treatment parameters, including peripheral dose and number of isocenters, in a multivariate analysis. The Spetzler-Martin grading scale and the Radiosurgery-Based Grading Scale predicted favorable outcome, but the Virginia Radiosurgery AVM Scale provided the best assessment.Conclusions. Gamma Knife radiosurgery can be used to achieve long-term AVM obliteration and neurological preservation in a predictable fashion based on patient and AVM characteristics.

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“…adiosurgery is an effective treatment alternative for cerebral arteriovenous malformations [1][2][3][4] and intracranial dural arteriovenous fistulas (DAVFs). [5][6][7][8][9][10] In AVM/DAVF radiosurgery, irradiation is delivered in a single fraction stereotactically to only the nidus of an AVM or fistula of a DAVF.…”

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confidence: 99%

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

Chen

Guo²,

Yang

et al. 2017

AJNR Am J Neuroradiol

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Stereotactic Radiosurgery in Intracranial Arterio-Venous Malformations

Cited by 75 publications

References 7 publications

A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

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