Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain

Parkhutik, Vera; Lago, Aída; Aparici, Fernando; Vázquez, Juan; Tembl, José Ignacio; Guillen, Lourdes; Mainar, Esperanza; Vázquez, Víctor

doi:10.1007/s00234-012-1115-8

Cited by 36 publications

(33 citation statements)

References 21 publications

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“…30% of patients treated with SRS for AVMs, follow-up neuroimaging studies demonstrated transient changes, namely a high-signal region on T2weighted spin-echo MRI or a low attenuation area on CT in areas surrounding the treatment volume that had previously appeared normal. 15,22,26,29,31 Levegrün et al 28 and Tu et al 49,50 attributed these image-defined responses following AVM SRS to either postradiation changes (i.e., blood-brain barrier injury or interstitial vasogenic edema or both) or to a local biological effect in the adjacent brain parenchyma (i.e., reactive astrogliosis) in response to AVM obliteration. Kondziolka et al 31 reported that the incidence of appearance of transient perilesional brain edema is more frequent after SRS for AVMs than after SRS for brain tumors.…”

Section: Discussionmentioning

confidence: 99%

“…[23][24][25] In $ 30% of patients treated with SRS for AVMs, follow-up neuroimaging studies demonstrated transient changes, namely a high-signal region on T2-weighted spin-echo MRI in areas surrounding the target and that had previously appeared normal. 23,[26][27][28][29] These changes are usually observed 6 to 18 months after SRS and are frequently transient. 27,30 The purpose of the present work was to study the MRIdefined changes following photon SRS of AVMs and specifically to correlate the appearance of perinidal T2 hyperintensity signal with the eventual angiographic obliteration of the AVM nidus in response to SRS treatment.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of Appearance of MRI Perinidal T2 Hyperintensity Signal and Eventual Nidus Obliteration Following Photon Radiosurgery of Brain AVMs: Combined Results of LINAC and Gamma Knife Centers

Abdelaziz

Shereen

Inoue

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background A wide variety of radiologic changes occur within and adjacent to the nidus of arteriovenous malformations (AVMs) after stereotactic radiosurgery (SRS). Our objective was to study the magnetic resonance imaging(MRI)-defined changes following photon radiosurgery of AVMs and specifically to correlate the appearance of a perinidal T2 hyperintensity signal with the eventual angiographic obliteration of an AVM nidus in response to SRS treatment. Material and Methods This retrospective study was conducted on 62 patients with brain AVMs who received photon SRS treatments between 2004 and 2017, using either a technique based on a linear accelerator at the Alexandria LINAC Radiosurgery Center in Egypt (21 patients/AVMs) or a technique based on a gamma unit at the Koto Memorial Gamma Knife Center in Japan (41 patients/AVMs). All patients included in the study had serial clinical and radiologic follow-ups for ≥ 2 years after SRS treatments. Results In the combined study series of 62 patients/AVMs treated with photon SRS, the follow-up MRIs revealed that 50 AVMs (80.6%) showed nonvisualized nidus and 12 AVMs (19.4%) showed decreased nidus size. Radiation-induced changes, defined as appearance of perinidal T2 hyperintensities in post-SRS MRIs, occurred in 34 patients (54.8%). Of the 35 patients with available follow-up angiographic studies, 30 AVMs (85.7%) demonstrated complete nidus obliteration at a mean of 36 months (range: 8–66 months) after SRS. Of the 30 AVMs with both MRI evidence of a nonvisualized nidus and angiographic verification of complete nidus obliteration, 20 AVMs (66.7%) were associated with prior MRI evidence of the appearance of a perinidal T2 hyperintensity signal at an average of 12 months (range: 6–45 months) after SRS. Of the five AVMs with both MRI evidence of decreased nidus size and angiographic verification of partial nidus obliteration, four AVMs (80%) showed perinidal T2 hyperintensity signal on post-SRS follow-up MRIs. Lower Spetzler-Martin grade (p = 0.013), smaller AVM volume (p = 0.017), and appearance of post-SRS perinidal T2 hyperintensity signal (p = 0.007) were the statistically significant independent predictors of AVM obliteration. The appearance of perinidal T2 hyperintensity signal in the post-SRS MRIs had a sensitivity of 66.7%, a specificity of 20%, and an overall accuracy of 60% in predicting the eventual obliteration of the AVM nidus. Conclusions The present study may help improve our current understanding of the mechanisms behind the radiation-induced tissue changes following AVM SRS. Because the SRS-induced hemodynamic changes within the AVM nidus initiate the cascade of the subsequent formation of perinidal vasogenic brain edema, the appearance of perinidal high T2 signal in the follow-up MRIs after SRS would be a valuable indicator of the AVM response to SRS. The development of perinidal hyperintensity was the strongest predictive factor of AVM obliteration (p = 0.007), with relatively high sensitivity (66.7%) and accuracy (60%) and fairly low specificity (20%), as a prognostic sign of eventual complete angiographic obliteration of the AVM nidus following SRS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Correlation of Appearance of MRI Perinidal T2 Hyperintensity Signal and Eventual Nidus Obliteration Following Photon Radiosurgery of Brain AVMs: Combined Results of LINAC and Gamma Knife Centers

Abdelaziz

Shereen

Inoue

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…We report no post-treatment hemorrhage, 4.5% (1/22) of patients developing perilesional edema, and no radiation necrosis at an average dose of 15.6Gy. Parkhtik et al 49 , in a study of 102 patients, noted perilesional edema in 43.1% of patients and had 6.9% of patients develop radiation necrosis with an average radiation dose of 18.5 Gy. Similarly the University of Pittsburgh group 50 has reported the development of perilesional imaging changes in approximately 30% of patients in numerous studies.…”

Section: Discussionmentioning

confidence: 99%

Use of Cone-Beam Computed Tomography Angiography in Planning for Gamma Knife Radiosurgery for Arteriovenous Malformations

Safain¹,

Rahal²,

Raval³

et al. 2014

Neurosurgery

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Background The effectiveness of Gamma Knife radiosurgery (GKR) for cerebral arteriovenous malformations (AVM) is predicated on inclusion of the entire nidus while excluding normal tissue. As such, GKR may be limited by the resolution and accuracy of the imaging modality used in targeting. Objective We present the first case series to demonstrate the feasibility of utilizing ultra-high-resolution C-arm cone beam computed tomography angiography (CBCT-A) in AVM targeting. Methods From June 2009 to June 2013, CBCT-A was utilized for targeting of all patients with AVMs treated with GKR at our institution. Patients underwent Leksell stereotactic head frame placement followed by catheter-based biplane 2-D digital subtraction angiography (DSA), 3-D rotational angiography (3DRA), as well as CBCT-A. The CBCT-A dataset was used for stereotactic planning for GKR. Patients were followed up at 1, 3, 6, and 12 months, and then annually thereafter. Results CBCT-A-based targeting was used in twenty-two consecutive patients. CBCT-A provided detailed spatial resolution and sensitivity of nidal angioarchitecture enabling treatment. The average radiation dose to the margin of the AVM nidus corresponding to the 50% percent isodose line was 15.6 Gy. No patient had treatment-associated hemorrhage. At early follow-up (mean=16 months), 84% of patients had a decreasing or obliterated AVM nidus. Conclusion CBCT-A-guided radiosurgery is feasible and useful because it provides sufficient detailed resolution and sensitivity for imaging brain AVMs.

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“…28 Late complications can include cyst formation, progressive vasogenic edema, and chronic expanding hematoma development. 16,25,26 Preliminary data from Lee and colleagues (Lee CC et al, unpublished data) have shown that the risks of adverse radiation effects are reduced if radiation exposure of intervening normal brain is minimized, especially in diffuse forms of AVMs. These authors have therefore developed, using fuzzy c-means clustering techniques, a method of separating CSF, brain tissue, and AVM vasculature on high-resolution T2-weighted images, producing color-coded maps of the AVM showing these 3 components separately in order to help guide GKSRS planning.…”

Section: Imaging Techniquesmentioning

confidence: 99%

Proceedings of the 2018 next-generation Gamma Knife research meeting

Chiang

Chao

Tuleasca

et al. 2018

Journal of Neurosurgery

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In order to determine what areas of research are a clinical priority, a small group of young Gamma Knife investigators was invited to attend a workshop discussion at the 19th International Leksell Gamma Knife Society Meeting. Two areas of interest and the need for future radiosurgical research involving multiple institutions were identified by the young investigators working group: 1) the development of additional imaging sequences to guide the understanding, treatment, and outcome tracking of diseases such as tremor, radiation necrosis, and AVM; and 2) trials to clarify the role of hypofractionation versus single-fraction radiosurgery in the treatment of large lesions such as brain metastases, postoperative cavities, and meningiomas.

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Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain

Abstract: Major radiation injury is frequent and increases the risk of neurological complications. Its late appearance implies that current follow-up protocols need to be extended in time.

Cited by 36 publications

References 21 publications

Correlation of Appearance of MRI Perinidal T2 Hyperintensity Signal and Eventual Nidus Obliteration Following Photon Radiosurgery of Brain AVMs: Combined Results of LINAC and Gamma Knife Centers

Correlation of Appearance of MRI Perinidal T2 Hyperintensity Signal and Eventual Nidus Obliteration Following Photon Radiosurgery of Brain AVMs: Combined Results of LINAC and Gamma Knife Centers

Use of Cone-Beam Computed Tomography Angiography in Planning for Gamma Knife Radiosurgery for Arteriovenous Malformations

Proceedings of the 2018 next-generation Gamma Knife research meeting

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