Late recovery of stereotactic radiosurgery induced perilesional edema of an arteriovenous malformation after bevacizumab treatment

Uysal, Ece; Başkurt, Ozan; Avci, İdris; Peker, Halil Olgun; Çelik, Suat Erol

doi:10.1080/02688697.2020.1742294

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Turner et al [2] reported full recovery from steroid-refractory RIN post-SRS for AVM, including complete resolution of severe headaches and hemiparesis with bevacizumab. Uysal et al [15] reported a patient with steroid-resistant RIN post-SRS for AVM who experienced improvement in headache, hemiparesis, and ambulation along with significant resolution of perilesional edema on computed tomography [15].…”

Section: Discussionmentioning

confidence: 99%

Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature

et al. 2021

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Stereotactic radiosurgery (SRS) is a proven treatment modality for inoperable arteriovenous malformations (AVMs). However, the rate of radiation-induced necrosis (RIN) is as high as 10%. A 6-year-old female patient presented with severe headache, emesis, and syncope, and workup revealed a Spetzler-Martin grade 4 AVM with intraventricular hemorrhage and hydrocephalus. The patient underwent a right frontal ventriculostomy followed by a linear accelerator-based SRS of 16.9 Gy. At 19 years, she developed progressive neurological symptoms. Diagnostic magnetic resonance imaging (MRI) revealed a recurrent parietal AVM nidus. We delivered the linear accelerator-based SRS of 18.5 Gy to the AVM nidus. Within 9 months, she experienced episodic headaches and left-sided weakness and spasticity; symptoms were initially managed with dexamethasone. Follow-up MRI was notable for edema and nondetectable blood flow, consistent with RIN and AVM obliteration. The second course of steroids did not provide the symptom control. Persistent RIN was noted on MRI, and she had stigmata of steroid toxicity (centripetal obesity, depression, and sleep disorder). Two infusions of bevacizumab (5 mg/kg) were administered concurrently with a tapering dose of dexamethasone. The patient noted a near immediate improvement in her headaches, and 2 months following the second bevacizumab infusion, she reported a near-complete resolution of her symptoms and displayed improved ambulation. The development of RIN remains a noteworthy concern post-SRS of AVMs. While steroids aid with initial management of RIN, for persistent and recurrent symptoms, bevacizumab infusions serve as a viable treatment course, with the added benefit of reducing the likelihood of adverse effects resulting from prolonged steroid therapy.

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Section: Discussionmentioning

confidence: 99%

Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature

et al. 2021

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“…75) Uysal et al reported a case of perilesional edema of an AVM after SRS that showed brain edema reduction. 76) However, anti-VEGF treatments have significant side effects, such as a higher risk of hemorrhage. 77) An angiotensin II receptor antagonist for hypertension treatment, losartan, reduced vascular dysplasia and arteriovenous shunting in a zebrafish model of bAVMs induced by knockdown of the TGF-β receptor ALK1.…”

Section: Future Therapeutic Targetsmentioning

confidence: 99%

An Updated Review on the Pathogenesis of Brain Arteriovenous Malformations and Its Therapeutic Targets

Ota

2024

JNET

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Brain arteriovenous malformations (bAVMs) are associated with a high risk of intracerebral hemorrhage, which causes severe complications in patients. Although the genetic factors leading to hereditary bAVMs have been extensively investigated, their pathogenesis are still under study. This review examines updated data on the molecular and genetic aspects of bAVMs, the architecture of microvasculature, the roles of angiogenic factors, and signaling pathways. The compiled information may help us understand the pathogenesis of both sporadic and hereditary bAVMs and develop appropriate preemptive treatment approaches.

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“…It reduced neurological deficits and perilesional edema poststereotactic radiosurgery in patients. 37 Similarly, MMP inhibitors, tetracyclines, have been studied for their biological activity against bAVMs. A few studies have examined the effect of doxycycline in reducing MMP-9 in AVMs.…”

Section: Molecular Drug Targets In Bavmmentioning

confidence: 99%

Molecular Biomarkers and Drug Targets in Brain Arteriovenous and Cavernous Malformations: Where Are We?

Venugopal

Sumi

2022

Stroke

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Vascular malformations of the brain (VMB) comprise abnormal development of blood vessels. A small fraction of VMBs causes hemorrhages with neurological morbidity and risk of mortality in patients. Most often, they are symptomatically silent and are detected at advanced stages of disease progression. The most common forms of VMBs are arteriovenous and cavernous malformations in the brain. Radiopathological features of these diseases are complex with high phenotypic variability. Early detection of these malformations followed by preclusion of severe neurological deficits such as hemorrhage and stroke is crucial in the clinical management of patients with VMBs. The technological advances in high-throughput omics platforms have currently infused a zest in translational research in VMBs. Besides finding novel biomarkers and therapeutic targets, these studies have withal contributed significantly to the understanding of the etiopathogenesis of VMBs. Here we discuss the recent advances in predictive and prognostic biomarker research in sporadic and familial arteriovenous malformations as well as cerebral cavernous malformations. Furthermore, we analyze the clinical applicability of protein and noncoding RNA-based molecular-targeted therapies which may have a potentially key role in disease management.

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Late recovery of stereotactic radiosurgery induced perilesional edema of an arteriovenous malformation after bevacizumab treatment

Cited by 5 publications

References 30 publications

Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature

Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature

An Updated Review on the Pathogenesis of Brain Arteriovenous Malformations and Its Therapeutic Targets

Molecular Biomarkers and Drug Targets in Brain Arteriovenous and Cavernous Malformations: Where Are We?

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