Symptomatic Radionecrosis after AVM Stereotactic Radiosurgery

Abstract

<jats:p> The purpose of our study was to analyze the outcome of symptomatic radionecrosis following stereotactic radiosurgery for brain arterio venous malformations. Of 225 patients treated by linear accelerator radiosurgery for brain AVM, 16 (7, 1%) presented post-radiosurgery symptomatic radionecrosis on a mean follow-up period of 50 months (range 1–123 months). Once diagnosed with radionecrosis, 14 of 16 patients were subjected to high dose corticotherapy consisting of escalating doses of dexamethasone for several weeks. The mean interval of occurrence of new symptoms was 11.6 months post-radiosurgery (range 6–20 months). The mean time of follow-up was 2.9 years post radiotherap y ranging from seven months to eight years. Of the 16 patients with symptomatic radionecrosis, 11 (68, 75%) showed complete resolution of symptoms while five (31, 25%) showed improvement but still presented a neurological deficit at the closing date of the study. At the closing date, 11 patients (68.75%) had angiographically completely obliterated arterio venous malformations while another two patients had an obliteration of 95% to 98% and one patient had a 98% obliteration with development of a new contralateral AVM. In our series, symptomatic radionecrosis occurred in 7.1% of patients treated with stereotactic radiosurgery for brain AVM. </jats:p><jats:p> These patients where subjected to a prompt, high dose corticosteroid treatment and most presented symptom resolution or improvement with a fair obliteration rate, offering protection from bleeding. Permanent neurologic deficits attributable to radionecrosis occurred in 2.2% of our patient population treated with stereotactic radiosurgery for brain AVM. </jats:p>

Case Report: Microsurgical excision of grade 5 cerebral AVM

“…The risk of hemorrhage in this time period is around 4.8% per year 14 which parallels the natural history of the lesion after bleeding. However there is a risk of inadvertent radiation injury to the adjacent eloquent brain area 15 and also a risk of symptomatic radiation necrosis in around 9% of cases 15, 16 .…”

7 tesla imaging of cerebral radiation necrosis after arteriovenous malformations treatment using amide proton transfer (APT) imaging

“…Its overall occurrence is indicated to be 0-10%, dependent on the study population (8)(9)(10). The impact of radiation on the surrounding brain tissue leads to persisting T2 signal changes in up to 12% of the patients and approximately 1.7% long-term complications (11).…”

Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis

“…Radiological RICs were defined as any new signal change in the T2 or fluid-attenuated inversion recovery (FLAIR) sequence after the SRS [26] , [27] , [28] . Radionecrosis was defined as a lesion with a central rim or irregular nodular enhancement with or without edema and it was reported by a neuroradiologist [29] . Cyst formation and chronic encapsulated hematoma were subtypes of late AREs [27] , [30] , [31] .…”