The role of high-dose, single-fraction irradiation in small and large intracranial arteriovenous malformations

Engenhart, R.; Wowra, B.; Debus, Jürgen; Kimmig, B.; Höver, K. H.; Lorenz, Walter J.; Wannenmacher, M.

doi:10.1016/0360-3016(92)90937-d

Cited by 108 publications

(25 citation statements)

References 29 publications

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“…The results from this series of 48 patients treated for AVMs with linear accelerator-based SRS are consistent with other series reported in the literature which suggest complete nidus obliteration in 60-90% of patients 15,[22][23][24][25][26] . The AVMs were initially treated with Gamma Knife radiosurgery 13 27 reported on their four year experience in 65 patients with AVMs using SRS for smaller lesions (<3cm diameter) and Spetzler-Martin grades 1 and 2.…”

Section: Discussionsupporting

confidence: 91%

Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Herbert

Moiseenko²,

McKenzie³

et al. 2011

Can. J. Neurol. Sci.

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Intracranial arteriovenous malformations (AVMs) are congenital lesions consisting of focal areas of abnormal dilated arteries and veins within the brain parenchyma. Small arterioles within the AVM have an absent smooth muscle layer and lack a capillary bed 1 . This results in arteriovenous shunting through one or more fistulae. This direct shunting leads to a risk of venous rupture due to the high pressures involved with potentially devastating consequences 2 . The prevalence of intracranial arteriovenous malformation in the general population is estimated to be anywhere between 0.001% and 0.52% [3][4][5][6] . Typically patients present following an intracerebral haemorrhage (42-72%), most commonly between the ages of 20 and 40 years 3,[7][8][9][10] . Other presenting symptoms include seizures, ABSTRACT: Objective: To investigate predictive factors of complete obliteration following treatment with linac-based stereotactic radiosurgery for intracerebral arteriovenous malformations. Methods: Archived plans for 48 patients treated at the British Columbia Cancer Agency and who underwent post-treatment digital subtraction angiography to assess obliteration were studied. Actuarial estimates of obliteration were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of obliteration. Log-rank test was used to search for parameters associated with obliteration. Results:Complete nidus obliteration was achieved in 38/48 patients (79.2%). Actuarial rate of obliteration was 75.9% at 4 years (95% confidence interval 63.1%-88.6%). On univariate analysis, prescribed dose to the margin (p=0.002) and dose to isocentre (p=0.022) showed statistical significance. No parameters were significant in a multivariate model. According to the log-rank test, prescribed dose to the margin of >20 Gy (p=0.004) and dose to the isocentre of >25 Gy (p=0.004) were associated with obliteration. Conclusion: Reported series in the literature suggest a number of different factors are predictive of complete obliteration of arteriovenous malformations following radiosurgery. However, differing definitions of volume and complete obliteration makes direct comparison between series difficult. This study demonstrates that complete obliteration of the nidus following linear accelerator-based stereotactic radiosurgery for arteriovenous malformations appears to be most closely related to the prescribed marginal dose. In particular, a marginal dose of >20Gy is strongly associated with obtaining complete obliteration of the nidus. RÉSUMÉ: Facteurs de prédiction de l'oblitération par la radio chirurgie de malformations artérioveineuses.Objectif : Le but de l'étude était de déterminer quels sont les facteurs de prédiction d'une oblitération complète de malformations artérioveineuses intracérébrales suite au traitement par radio chirurgie stéréotaxique par Linac. Méthodes : Nous avons étudié le plan de traitement de 48 patients, qui ont subi une angiographie de soustraction numérique ...

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Section: Discussionsupporting

confidence: 91%

Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Herbert

Moiseenko²,

McKenzie³

et al. 2011

Can. J. Neurol. Sci.

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“…In the study of Schlienger et al 13 , overall obliteration rate was 64% (108/169 patients) and median AVM size was 22 mm (range; 8-51mm) with a median peripheral dose of 25 Gy (range; 15-28Gy). Engenhart et al 16 reported in their study that the degree of obliteration was associated with dose; complete obliteration rate to be 0% in 13 patients with doses ≤ 14 Gy, 50% for the 15-16 Gy group, and 80% for patients with doses ≥ 20 Gy in their study.…”

Section: Discussionmentioning

confidence: 97%

“…5,16 In the study of Friedman et al 5 , complete obliteration was 81% for 1-4cc, 89% for 4-10cc, and 69% for > 10cc. Miyawaki et al17 found obliteration rates of 67% for < 4cc, 58% for 4-13.9 cc, and 23% for ≥ 14cc; higher minimal doses were significantly associated with AVM obliteration.…”

Section: Discussionmentioning

confidence: 99%

Management of Arteriovenous Malformations by Stereotactic Radiosurgery: A Single Center Experience

F¹,

Sager²,

Gamsiz³

et al. 2012

UHOD

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The aim of this monoinstitutional study is to evaluate the efficiency of stereotactic radiosurgery (SRS) in the management of arteriovenous malformations (AVM). Between June 1998 and July 2011, 51 patients with AVM were treated with linear accelerator-based SRS at our department. All patients were preevaluated for AVM size, location, neurological status, previous history of hemorrhage and Spetzler-Martin grading. Treated patients then underwent follow-up to evaluate obliteration and clinical status. Median followup time was 32 months (range; 20-93 months). Spetzler-Martin grade I-II and AVM sizes below 3 cm were associated with increased obliteration rate (p=0.01). The annual hemorrhage risk was 1.9%. No patients experienced deterioration of neurological status at follow-up. LINAC-based SRS is a safe and effective treatment modality in the management of cerebral AVMs. SRS comprises an effective alternative to surgery for the treatment of particularly small AVMs inaccessible with surgery. Keywords: Arteriovenous malformation, Stereotactic radiosurgery, Spetzler-Martin grading, SRS, Hemorrhage ÖZET Arteriovenöz malformasyonlar›n Manajman›nda Stereotaktik Radyocerrahi: Tek Menkez DeneyimiBu tek merkezli çal›flman›n amac› stereotaktik radyocerrahinin (SRS) arteryovenöz malformasyon (AVM) manajman›ndaki etkinli¤inin de¤erlendirilmesidir. Klini¤imizde Haziran 1998 ile Temmuz 2011 tarihleri aras›nda arteryovenöz malformasyonlu 51 hasta Linak tabanl› stereotaktik radyocerrahi ile tedavi edilmifltir. Tedavi öncesinde tüm hastalar AVM boyutu, lokalizasyonu, nörolojik durum, ön-ceden kanama öyküsü ve Spetzler-Martin derecelendirilmesi aç›s›ndan de¤erlendirilmifltir. Tedavi sonras›nda hastalar obliterasyon durumu ve klinik durum de¤erlendirmesi için takip edilmifltir. Medyan takip süresi 32 ay (s›n›rlar; 20-93 ay) idi. Spetzler-Martin derece I-II ve AVM boyutunun 3 cm'den küçük olmas› artm›fl obliterasyon oran› ile iliflkiliydi (p=0.01). Y›ll›k kanama oran› %1.9 idi. Takip süresinde hiçbir hastada nörolojik durumda kötüleflme gözlenmedi. LINAC tabanl› stereotaktik radyocerrahi serebral AVM manajman›nda güvenli ve efektif bir tedavi modalitesidir. Stereotaktik radyocerrahi özellikle cerrahi ile ulafl›lamayan küçük AVM'lerin tedavisi için cerrahiye efektif bir alternatif oluflturmaktad›r.

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“…Possibly, such complications would not have occurred had the AVM only been treated by radiosurgery. 2,16,21) On the other hand, these complications did not cause any permanent morbidity. When choosing radiosurgery as therapeutic option, stereotactic planning may be difficult for lesions associated with SAH located close to the brain stem.…”

Section: Discussionmentioning

confidence: 99%

“…When choosing radiosurgery as therapeutic option, stereotactic planning may be difficult for lesions associated with SAH located close to the brain stem. 2,3,21) AVMs cannot be obliterated immediately after radiosurgery 23) since the mechanism of radiation-induced blood vessel obliteration is gradual occlusion of the vessels, which remain in situ. Moreover, radiosurgery may not prevent significant rebleeding after this treatment.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Malformation Surrounding the Trigeminal Nerve-Case Report-

Krischek

Yamaguchi

Sure

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 57-year-old man presented with subarachnoid hemorrhage due to the rupture of an arteriovenous malformation (AVM) located at the base of the root of the right trigeminal nerve. In contrast to previous similar cases, his history included no evidence of trigeminal neuralgia or sensory loss. Right vertebral artery angiography revealed a doubled superior cerebellar artery feeding the angioma nidus. The patient refused radiotherapy and preferred surgical treatment. Intraoperatively, a close relationship between arterial feeders and rootlets of the trigeminal nerve was observed. Complete removal of the malformation was achieved and confirmed angiographically. The postoperative course was complicated by subdural hygroma that required repeated drainage and eventually a shunting procedure. This case demonstrates that microsurgical treatment of a trigeminal AVM is feasible. However, stereotactic radiosurgery may be the preferred treatment option considering the potential for postoperative complications.

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The role of high-dose, single-fraction irradiation in small and large intracranial arteriovenous malformations

Cited by 108 publications

References 29 publications

Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Management of Arteriovenous Malformations by Stereotactic Radiosurgery: A Single Center Experience

Arteriovenous Malformation Surrounding the Trigeminal Nerve-Case Report-

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