Stereotactic radiosurgery for pediatric brain arteriovenous malformations: long-term outcomes

Chen, Ching-Jen; Lee, Cheng‐Chia; Kano, Hideyuki; Kearns, Kathryn N.; Ding, Dale; Tzeng, Shih-Wei; Atik, Ahmet; Joshi, Krishna C.; Barnett, Gene H.; Huang, Paul P.; Kondziolka, Douglas; Mathieu, David; Iorio-Morin, Christian; Grills, I.S.; Quinn, Thomas J.; Siddiqui, Z.A.; Marvin, K.; Feliciano, Caleb; Lunsford, L. Dade; Sheehan, Jason P.

doi:10.3171/2019.12.peds19595

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…A literature search for articles where the 2-year hemorrhage rate and the number of risk years within the first 2 years after GKS can be extracted, calculated or estimated, with at least 100 patients studied, yielded 12 references. 1,6,8,10-18 The sum of risk years was 9799 and the number of hemorrhages 216, representing an average annual hemorrhage rate of 2.2%, similar to the 2.4% found in our study.…”

Section: Discussionsupporting

confidence: 86%

Risk for Hemorrhage the First 2 Years After Gamma Knife Surgery for Arteriovenous Malformations: An Update

et al. 2022

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BACKGROUND: Knowledge about the natural course of brain arteriovenous malformations (AVMs) have increased during the past 20 years, as has the number of AVMs treated, especially larger ones. It is thus timely to again analyze the risk for hemorrhage after Gamma Knife Surgery (GKS). OBJECTIVE: To confirm or contradict conclusions drawn 20 years ago regarding factors that affect the risk for post-GKS hemorrhage. METHODS: The outcome after GKS was studied in 5037 AVM patients followed for up to 2 years. The relation between post-treatment hemorrhage rate and a number of patient, AVM, and treatment parameters was analyzed. The results were also compared with the results from our earlier study. RESULTS: The annual post-treatment hemorrhage rate was 2.4% the first 2 years after GKS. Large size, low treatment dose, and old age were independent risk factors for AVM hemorrhage. After having compensated for the factors above, peripheral AVM location and female sex, at least during their child bearing ages, were factors associated with a lower post-GKS hemorrhage rate. CONCLUSION: Large AVMs (>5 cm 3 ) treated with low doses (≤16 Gy) had higher and small AVMs treated with high doses a lower risk for hemorrhage as compared with untreated AVMs. This was detectable within the first 6 months after GKS. No difference in hemorrhage rate could be detected for the other AVMs. Based on our findings, it is advisable to prescribe >16 Gy to larger AVMs, assuming that the risk for radiation-induced complications can be kept at an acceptable level.

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Section: Discussionsupporting

confidence: 86%

Risk for Hemorrhage the First 2 Years After Gamma Knife Surgery for Arteriovenous Malformations: An Update

et al. 2022

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“…One patient in our series developed a cyst adjacent to the hematoma, which has been described in 1%-3% of AVM SRS experiences. 30,31 Hasegawa and colleagues 19 calculated a cumulative incidence of cyst formation and CEEH of 0.6% at 3 years, 1.2% at 5 years, 5.2% at 10 years, 6.3% at 15 years, and 16.0% at 20 years for pediatric patients and 0.8% at 5 years, 2.8% at 10 years, and 7.6% at 15 years for adult patients who underwent SRS for AVM treatment.…”

Section: Factors That May Lead To the Development Of Ceehmentioning

confidence: 99%

Chronic encapsulated expanding hematomas after stereotactic radiosurgery for intracranial arteriovenous malformations

Abou‐Al‐Shaar¹,

Zhang²,

Mallela³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Cerebral arteriovenous malformations (AVMs) are rare cerebral vascular lesions that are associated with high morbidity and mortality from hemorrhage; however, stereotactic radiosurgery (SRS) is a well-validated treatment modality. Few reports have delineated a subgroup of patients who develop delayed chronic encapsulated expanding hematomas (CEEHs) despite angiographic evidence of AVM obliteration following radiosurgery. In this report, the authors performed a retrospective review of more than 1000 radiosurgically treated intracranial AVM cases to delineate the incidence and management of this rare entity. METHODS Between 1988 and 2019, 1010 patients with intracranial AVM underwent Gamma Knife SRS at the University of Pittsburgh Medical Center. In addition to a review of a prospective institutional database, the authors performed a retrospective chart review of the departmental AVM database to specifically identify patients with CEEH. Pertinent clinical and radiological characteristics as well as patient outcomes were recorded and analyzed. RESULTS Nine hundred fifty patients with intracranial AVM (94%) had sufficient clinical follow-up for analysis. Of these, 6 patients with CEEH underwent delayed resection (incidence rate of 0.0045 event per person-year). These patients included 4 males and 2 females with a mean age of 45.3 ± 13.8 years at the time of initial SRS. Four patients had smaller AVM volumes (4.9–10 cm3), and 3 of them were treated with a single SRS procedure. Two patients had larger-volume AVMs (55 and 56 cm3), and both underwent multimodal management that included staged SRS and embolization. Time to initial recognition of the CEEH after initial SRS ranged between 66 and 243 months. The time between CEEH recognition and resection ranged from 2 to 9 months. Resection was required because of progressive neurological symptoms that correlated with imaging evidence of gradual hematoma expansion. All 6 patients had angiographically confirmed obliteration of their AVM. Pathology revealed a mixed chronicity hematoma with areas of fibrosed blood vessels and rare areas of neovascularization with immature blood vessels but no evidence of a persistent AVM. All 6 patients reported persistent clinical improvement after hematoma resection. CONCLUSIONS CEEH after SRS for AVM is a rare complication with an incidence rate of 0.0045 event per person-year over the authors’ 30-year experience. When clinical symptoms progress and imaging reveals progressive enlargement over time, complete resection of a CEEH results in significant clinical recovery. Knowledge of this rare entity facilitates timely detection and eventual surgical intervention to achieve optimal outcomes.

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“…Entities and lesions such as vestibular schwannomas, pituitary adenomas, meningiomas, neurocytoma, and small metastases may be effectively addressed with this treatment modality [ 3 , 4 , 21 , 35 , 43 ]. Similar to adults, recent data also suggest AVMs to be a suitable pediatric SRS target [ 6 , 44 ]. In contrast, diffuse tumor growth usually dictates other treatment options, such as surgery or fractionated radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Applications of Frameless Image-Guided Robotic Stereotactic Radiotherapy and Radiosurgery in Pediatric Neuro-Oncology: A Systematic Review

Ehret

Kaul

Budach

et al. 2022

Cancers

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Background: CyberKnife-based robotic radiosurgery (RRS) is a widely used treatment modality for various benign and malignant tumors of the central nervous system (CNS) in adults due to its high precision, favorable safety profile, and efficacy. Although RRS is emerging in pediatric neuro-oncology, scientific evidence for treatment indications, treatment parameters, and patient outcomes is scarce. This systematic review summarizes the current experience and evidence for RRS and robotic stereotactic radiotherapy (RSRT) in pediatric neuro-oncology. Methods: We performed a systematic review based on the databases Ovid Medline, Embase, Cochrane Library, and PubMed to identify studies and published articles reporting on RRS and RSRT treatments in pediatric neuro-oncology. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied herein. Articles were included if they described the application of RRS and RSRT in pediatric neuro-oncological patients. The quality of the articles was assessed based on their evidence level and their risk for bias using the original as well as an adapted version of the Newcastle Ottawa Quality Assessment Scale (NOS). Only articles published until 1 August 2021, were included. Results: A total of 23 articles were included after final review and removal of duplicates. Articles reported on a broad variety of CNS entities with various treatment indications. A majority of publications lacked substantial sample sizes and a prospective study design. Several reports included adult patients, thereby limiting the possibility of data extraction and analysis of pediatric patients. RRS and RSRT were mostly used in the setting of adjuvant, palliative, and salvage treatments with decent local control rates and acceptable short-to-intermediate-term toxicity. However, follow-up durations were limited. The evidence level was IV for all studies; the NOS score ranged between four and six, while the overall risk of bias was moderate to low. Conclusion: Publications on RRS and RSRT and their application in pediatric neuro-oncology are rare and lack high-quality evidence with respect to entity-related treatment standards and long-term outcomes. The limited data suggest that RRS and RSRT could be efficient treatment modalities, especially for children who are unsuitable for surgical interventions, suffer from tumor recurrences, or require palliative treatments. Nevertheless, the potential short-term and long-term adverse events must be kept in mind when choosing such a treatment. Prospective studies are necessary to determine the actual utility of RRS and RSRT in pediatric neuro-oncology.

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Stereotactic radiosurgery for pediatric brain arteriovenous malformations: long-term outcomes

Cited by 10 publications

References 31 publications

Risk for Hemorrhage the First 2 Years After Gamma Knife Surgery for Arteriovenous Malformations: An Update

Risk for Hemorrhage the First 2 Years After Gamma Knife Surgery for Arteriovenous Malformations: An Update

Chronic encapsulated expanding hematomas after stereotactic radiosurgery for intracranial arteriovenous malformations

Applications of Frameless Image-Guided Robotic Stereotactic Radiotherapy and Radiosurgery in Pediatric Neuro-Oncology: A Systematic Review

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