Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.</jats:p></jats:sec>

Radiosurgery for temporal lobe arteriovenous malformations: effect of temporal location on seizure outcomes

“…6 The present study conflicts with prior studies, which reported superior rates of posttreatment seizure control in patients with obliterated AVMs compared with those with patent AVMs. Hoh et al compared the seizure outcomes following multimodality treatment of 141 patients with seizures to 283 patients without seizures and found obliteration to be significantly associated with Engel Class I outcomes (p < 0.001).…”

Radiosurgery for Cerebral Arteriovenous Malformations in A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA)-Eligible Patients

“…[22][23][24][25] Radiosurgery is a minimally invasive modality for the treatment of AVMs, and it is especially favorable, relative to microsurgery, for small-to moderate-sized AVMs in eloquent or deep brain areas. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] The results of many previous radiosurgery series are confounded by the inclusion of patients who were previously treated with surgical resection, embolization, and fractionated radiation therapy. Thus, comparing the outcomes of these unfiltered studies to those of the interventional arm of ARUBA cannot lead to generalizable conclusions.…”

“…This estimate does not account for other neurological sequelae originating from a patent AVM, such as seizures and focal deficits secondary to chronic vascular steal. 27,38,[53][54][55][56][57] …”

Interhemispheric approach for endoscopic ligation of an anterior cranial fossa dural arteriovenous fistula

“…Additionally, DAVF with cortical venous drainage may be less responsive to radiosurgical treatment [14]. Due to the relatively low number of treated patients, the outcomes of DAVF radiosurgery have not been analyzed with the same rigor as those of radiosurgery for cerebral arteriovenous malformations [15][16][17][18][19][20][21][22][23][24][25]. Therefore, the effect of prior embolization on DAVF is poorly understood [26][27][28][29].…”