Changes in Angioarchitecture After Stereotactic Radiosurgery for Dural Arteriovenous Fistula

Maglinger, Benton; Hulou, M. Maher; McLouth, Christopher J.; Sands, Madison; Pokhrel, Damodar; Clair, William H. St.; Grupke, Stephen; Fraser, Justin F.

doi:10.1016/j.jstrokecerebrovasdis.2021.105676

Cited by 1 publication

(2 citation statements)

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“…Across a total of 21 published studies meeting our inclusion criteria, we identified 706 patients with 721 dAVFs treated with SRS. 12,13,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Patients were treated between 1994 and 2021 at institutions in the United States, Sweden, Canada, the United Kingdom, South Korea, Taiwan, Japan, Spain, and India. Data on both outcomes as well as patient age, median clinical and angiographic follow-up, proportion of patients who received previous surgery and/or embolization, the proportion of patients with previous hemorrhage or CVD, target volume size and Borden Class, and MPD are detailed in Table 1.…”

Section: Patient Study and Lesion Characteristicsmentioning

confidence: 99%

“…There were 19 studies with 688 lesions with data on CO rates. 12,13,[27][28][29][30][31][32][33][34][35][36][37][38][39][42][43][44][45] At final radiological follow-up, the pooled CO rate after SRS was 68.6% (95% CI 60.7%-76.5%; Figure 1). There was significant heterogeneity among the included studies.…”

Section: Complete Obliteration Symptom Cure and Symptom Improvement R...mentioning

confidence: 99%

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Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

et al. 2022

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BACKGROUND: Dural arteriovenous fistulas (dAVFs) are often treated with stereotactic radiosurgery (SRS) to achieve complete obliteration (CO), prevent future hemorrhages, and ameliorate neurological symptoms. OBJECTIVE: To summarize outcomes after SRS for dAVFs and propose relevant practice recommendations. METHODS: Using a PICOS/PRISMA/MOOSE protocol, we included patients with dAVFs treated with SRS and data for at least one of the outcomes of the study. Relevant outcomes were CO, symptom improvement and cure, and post-SRS hemorrhage or permanent neurological deficits (PNDs). Estimated outcome effect sizes were determined using weighted random-effects meta-analyses using DerSimonian and Laird methods. To assess potential relationships between patient and lesion characteristics and clinical outcomes, mixed-effects weighted regression models were used. RESULTS: Across 21 published studies, we identified 705 patients with 721 dAVFs treated with SRS. The CO rate was 68.6% (95% CI 60.7%-76.5%) with symptom improvement and cure rates of 97.2% (95% CI 93.2%-100%) and 78.8% (95% CI 69.3%-88.2%), respectively. Estimated incidences of post-SRS hemorrhage and PNDs were 1.1% (95% CI 0.6%-1.6%) and 1.3% (95% CI 0.8%-1.8%), respectively. Noncavernous sinus (NCS) dAVFs were associated with lower CO (P = .03) and symptom cure rates (P = .001). Higher grade was also associated with lower symptom cure rates (P = .04), whereas previous embolization was associated with higher symptom cure rates (P = .01). CONCLUSION: SRS for dAVFs results in CO in the majority of patients with excellent symptom improvement rates with minimal toxicity. Patients with NCS and/or highergrade dAVFs have poorer symptom cure rates. Combined therapy with embolization and SRS is recommended when feasible for clinically aggressive dAVFs or those refractory to embolization to maximize the likelihood of symptom cure.

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Section: Patient Study and Lesion Characteristicsmentioning

confidence: 99%

Section: Complete Obliteration Symptom Cure and Symptom Improvement R...mentioning

confidence: 99%

Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

et al. 2022

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Changes in Angioarchitecture After Stereotactic Radiosurgery for Dural Arteriovenous Fistula

Cited by 1 publication

References 19 publications

Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

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