Efficacy and morbidity of arc-therapy radiosurgery for cerebral arteriovenous malformations: a comparison with the natural history

Bollet, Marc A.; Anxionnat, René; Buchheit, I.; Bey, P.; Cordebar, A.; Jay, Nicolas; Désandes, Emmanuel; Marchal, C.; Lapeyre, M.; Aletti, P.; Picard, L

doi:10.1016/j.ijrobp.2003.09.005

Cited by 71 publications

(31 citation statements)

References 36 publications

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“…Other studies revealed no protective role of partially obliterated AVMs. 5 The risk of hemorrhage after SRS persists as long as the nidus remains patent. The relative higher hemorrhage rate after combined treatment may be partially explained by the fact that nidus size and AVM volume were larger in the embolized group than in the nonembolized group.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery with and without embolization for intracranial arteriovenous malformations: a systematic review and meta-analysis

Zhong

Ray

et al. 2014

FOC

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Object The effectiveness and risk of stereotactic radiosurgery (SRS) in the management of partially embolized intracranial arteriovenous malformations (AVMs) remain controversial. The aim of this analysis was to assess current evidence regarding the efficiency and safety of SRS for AVM patients with and without prior embolization. Methods To compare SRS in patients with and without embolization, the authors conducted a meta-analysis of studies by searching the literature via PubMed and EMBASE for the period between January 2000 and December 2013, complemented by a hand search. Primary outcome was the rate of AVM obliteration on a 3-year follow-up angiogram. Secondary outcome was the rate of hemorrhage at 3 years after SRS. Tertiary outcome was permanent neurological deficits related to radiation-induced changes. Results Ten studies eligible for analysis included 1988 patients: 593 had undergone embolization followed by SRS and 1395 had undergone SRS alone. The AVM obliteration rate was significantly lower in patients who had undergone embolization followed by SRS than in those who had undergone SRS alone (41.0% vs 59%, OR 0.46, 95% CI 0.37–0.56, p < 0.00001). However, the rates of hemorrhage (7.3% vs 5.6%, OR 1.17, 95% CI 0.74–1.83, p = 0.50) and permanent neurological deficits related to radiation-induced changes (3.3% vs 3.4%, OR 1.41, 95% CI 0.64–3.11, p = 0.39) were not significantly different between the two groups. Conclusions Embolization before SRS significantly decreases the AVM obliteration rate. However, there is no significant difference in the risk of hemorrhage and permanent neurological deficits after SRS alone and following embolization. Further validation by well-designed prospective or randomized cohort studies is still needed.

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Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery with and without embolization for intracranial arteriovenous malformations: a systematic review and meta-analysis

Zhong

Ray

et al. 2014

FOC

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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

195

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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“…Gamma knife radiosurgery (GKS) is accepted as an effective treatment modality for patients with a cerebral AVM 1,7,14,19,23) . The obliteration rate for cerebral AVMs at 3 years after GKS varies from 61.2 to 86.6%, mostly dependent upon the size of AVM and marginal dose 17,20,23) .…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis on 76 Cases of Cerebral Arteriovenous Malformations Treated by Gamma Knife Radiosurgery

Choe

Kim

et al. 2008

J Korean Neurosurg Soc

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Efficacy and morbidity of arc-therapy radiosurgery for cerebral arteriovenous malformations: a comparison with the natural history

Cited by 71 publications

References 36 publications

Stereotactic radiosurgery with and without embolization for intracranial arteriovenous malformations: a systematic review and meta-analysis

Stereotactic radiosurgery with and without embolization for intracranial arteriovenous malformations: a systematic review and meta-analysis

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

Retrospective Analysis on 76 Cases of Cerebral Arteriovenous Malformations Treated by Gamma Knife Radiosurgery

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