Validation of the radiosurgery-based arteriovenous malformation score in a large linear accelerator radiosurgery experience

Raffa, Scott J.; Chi, Yueh‐Yun; Bova, Frank J.; Friedman, William A.

doi:10.3171/2009.4.jns081532

Cited by 48 publications

(25 citation statements)

References 59 publications

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“…Infrequently addressed in our reviewed series, repeat SRS was successful in DAVF obliteration in 1 of 3 cases described. 9,21 Similar to the results of SRS for AVMs, 24,26 the general rate of obliteration across our literature review was 71%, with transient worsening seen in 9.1% of patients and permanent worsening seen in 2.4% of cases. Post-SRS hemorrhage only occurred in 1.6% of cases (4.8% of cases with CVD).…”

Section: Discussionsupporting

confidence: 56%

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Stereotactic radiosurgery for cerebral dural arteriovenous fistulas

Gross

Ropper²,

Popp³

et al. 2012

FOC

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Object Given the feasibility of curative surgical and endovascular therapy for cerebral dural arteriovenous fistulas (DAVFs), there is a relative paucity of radiosurgical series for these lesions as compared with their arteriovenous malformation counterparts. Methods The authors reviewed records of 56 patients with 70 cerebral DAVFs treated at their institution over the past 6 years. Ten DAVFs (14%) in 9 patients were treated with stereotactic radiosurgery (SRS), with follow-up obtained for 8 patients with 9 DAVFs. They combined their results with those obtained from a comprehensive review of the literature, focusing on obliteration rates, post-SRS hemorrhage rates, and other complications. Results In the authors' group of 9 DAVFs, angiographic obliteration was seen in 8 cases (89%), and no post-SRS hemorrhage or complications were observed after a mean follow-up of 2.9 years. Combining the results in these cases with data obtained from their review of the literature, they found 558 DAVFs treated with SRS across 14 series. The overall obliteration rate was 71%; transient worsening occurred in 9.1% of patients, permanent worsening in 2.4% (including 1 death, 0.2% of cases), and post-SRS hemorrhage occurred in 1.6% of cases (4.8% of those with cortical venous drainage [CVD]). The obliteration rate for cavernous DAVFs was 84%, whereas the rates for transversesigmoid and for tentorial DAVFs were 58% and 59%, respectively (adjusted p values, pcav,TS = 1.98 × 10−4, pcav,tent = 0.032). Obliteration rates were greater for DAVFs without CVD (80%, compared with 60% for those with CVD, p = 7.59 × 10−4). Both transient worsening and permanent worsening were less common in patients without CVD than in those with CVD (3.4% vs 7.3% for transient worsening and 0.9% vs 2.4% for permanent worsening). Conclusions Stereotactic radiosurgery with or without adjunctive embolization is an effective therapy for DAVFs that are not amenable to surgical or endovascular monotherapy. It is best suited for lesions without CVD and for cavernous DAVFs.

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Section: Discussionsupporting

confidence: 56%

“…9,10 A known positive prognostic factor for AVM obliteration after SRS, 24,26 obliteration as a function of smaller DAVF size was only specifically addressed in one study. 7 In this study, the obliteration rate was 75% for DAVFs smaller than or equal to 10 mm, decreasing to 64% for those larger than 10 mm.…”

mentioning

confidence: 99%

Stereotactic radiosurgery for cerebral dural arteriovenous fistulas

Gross

Ropper²,

Popp³

et al. 2012

FOC

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“…14 The RBAS has been validated by centers performing Gamma Knife SRS, linear accelerator-based SRS, and the CyberKnife SRS. [29][30][31] In the current series, patients with larger volume BAVM, and thus higher RBAS, were at greater risk of stoke or clinical impairment after SRS. For example, the 10-year risk of MRS ≥2 for patients with a RBAS ≤1.50 was 2%, compared with 13% at 5 years and 18% at 10 years for patients with a RBAS >1.50.…”

Section: February 2013mentioning

confidence: 91%

The Risk of Stroke or Clinical Impairment After Stereotactic Radiosurgery for ARUBA-Eligible Patients

Pollock

Link

Brown

2013

Stroke

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Background and Purpose-The best management of patients with unruptured brain arteriovenous malformations (BAVM) is controversial. In this study, we analyzed the stroke rate and functional outcomes of patients having stereotactic radiosurgery (SRS) for unruptured BAVM using the same eligibility criteria and primary end points as the ARUBA trial. Methods-Retrospective observational study of 174 ARUBA-eligible patients having SRS from 1990 to 2005. Results-The median follow-up after SRS was 64 months. Fifteen patients (8.7%) had a hemorrhagic stroke at a median of 21 months after SRS. Six patients (3.5%) had a focal neurological deficit and 4 patients died (2.3%). The risk of stroke or death was 10.3% at 5 years and 11.5% at 10 years. Twelve additional patients (6.9%) had a focal neurological deficit from either radiation-related complications (n=7) or subsequent resection (n=5). The risk of patients' having clinical impairment (modified Rankin Score ≥2) was 8.4% at 5 years and 12.0% at 10 years. Increasing BAVM volume was associated with both stroke or death (hazard ratio=1.06; 95% confidence interval, 1.0-1.11; P=0.04) and clinical impairment (hazard ratio=1.06; 95% confidence interval, 1.01-1.09; P=0.01). The 10-year risk of stroke or death and clinical impairment for patients with BAVM ≤5.6 cm 3 was 5% and 4%, respectively. Conclusions-The observed risk of stroke or death after SRS was approximately 2% per year for the first 5 years after SRS, declining to 0.2% annually for years 6 to 10. Patients with small volume BAVM may benefit from SRS compared with the natural history of unruptured BAVM over the planned follow-up interval of the ARUBA trial (5-10 years). (Stroke. 2013;44:437-441.)

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“…More recent series report hemorrhage after radiosurgery in 3% to 9% of patients [86,87], radiological imaging changes in up to 46% to 66% (severe in 19%) [84,88], transient neurological complications in 5% to 17% [89,90], and permanent neurological complications in 1% to 13% [89,91].…”

Section: Prognosismentioning

confidence: 99%