skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: Differences in obliteration rates, treatment-obliteration intervals, and prognostic factors

Abstract

Purpose: To evaluate and compare obliteration rates (OBRs) and treatment-obliteration intervals (TOIs) for cerebral arteriovenous malformations (cAVMs) treated with Gamma Knife radiosurgery in children/adolescents and adults; and to determine factors predicting the OBR and TOI in these two populations. Methods and Materials: This study concerned 62 children/adolescents and 193 adults observed for {>=}3 years. Fisher exact two-tailed and Wilcoxon rank-sum tests, multiple logistics, and Cox proportional hazard models were used for statistical analysis. Results: The overall OBR was 85.5% in children/adolescents and 87.6% in adults (p 0.671), but children/adolescents showed higher 36-month actuarial OBRs (69.35%) and shorter median TOIs (25.7 months) than adults (66.84% and 28.2 months; p 0.006 and p = 0.017, respectively). In children/adolescents, lower Spetzler-Martin grades (p = 0.043) and younger age (p = 0.019) correlated significantly with OBRs, and lower Spetzler-Martin grades (p 0.024) and noneloquent cAVM locations (p = 0.046) with TOIs. In adults, low flow through the cAVM and <6.2-cm{sup 3} volume were associated with both OBR and TOI (p 0.012 and p = 0.002, respectively). Conclusions: The differences in OBRs within 3 years and TOIs, although slight, seem to show that pediatric cAVMs behave differently from those in adults after Gamma Knife radiosurgery.

Authors:
 [1];  [2];  [3];  [4];  [2];  [3];  [2];  [3];  [2];  [3];  [2];  [3];  [2];  [3];  [2];  [3]
  1. Department of Neurosurgery, University of Verona and University Hospital, Verona (Italy) and Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona (Italy). E-mail: antonio.nicolato@mail.azosp.vr.it
  2. Department of Neurosurgery, University of Verona and University Hospital, Verona (Italy)
  3. (Italy)
  4. Interdepartmental Centre of Economic Documentation, University of Verona and University Hospital, Verona (Italy)
Publication Date:
OSTI Identifier:
20793364
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2005.09.013; PII: S0360-3016(05)02604-0; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ADOLESCENTS; CHILDREN; HAZARDS; MALFORMATIONS; RADIOTHERAPY; SURGERY

Citation Formats

Nicolato, Antonio, Lupidi, Francesco, Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona, Sandri, Marco F. Dr. Econom., Foroni, Roberto, Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona, Zampieri, Piergiuseppe, Section of Neuroradiology, University of Verona and University Hospital, Verona, Mazza, Carlo, Section of Pediatric Neurosurgery, University of Verona and University Hospital, Verona, Pasqualin, Alberto, Neurosurgical Clinic, University of Verona and University Hospital, Verona, Beltramello, Alberto, Section of Neuroradiology, University of Verona and University Hospital, Verona, Gerosa, Massimo, and Neurosurgical Clinic, University of Verona and University Hospital, Verona. Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: Differences in obliteration rates, treatment-obliteration intervals, and prognostic factors. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Nicolato, Antonio, Lupidi, Francesco, Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona, Sandri, Marco F. Dr. Econom., Foroni, Roberto, Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona, Zampieri, Piergiuseppe, Section of Neuroradiology, University of Verona and University Hospital, Verona, Mazza, Carlo, Section of Pediatric Neurosurgery, University of Verona and University Hospital, Verona, Pasqualin, Alberto, Neurosurgical Clinic, University of Verona and University Hospital, Verona, Beltramello, Alberto, Section of Neuroradiology, University of Verona and University Hospital, Verona, Gerosa, Massimo, & Neurosurgical Clinic, University of Verona and University Hospital, Verona. Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: Differences in obliteration rates, treatment-obliteration intervals, and prognostic factors. United States. doi:10.1016/J.IJROBP.2005.0.
Nicolato, Antonio, Lupidi, Francesco, Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona, Sandri, Marco F. Dr. Econom., Foroni, Roberto, Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona, Zampieri, Piergiuseppe, Section of Neuroradiology, University of Verona and University Hospital, Verona, Mazza, Carlo, Section of Pediatric Neurosurgery, University of Verona and University Hospital, Verona, Pasqualin, Alberto, Neurosurgical Clinic, University of Verona and University Hospital, Verona, Beltramello, Alberto, Section of Neuroradiology, University of Verona and University Hospital, Verona, Gerosa, Massimo, and Neurosurgical Clinic, University of Verona and University Hospital, Verona. Wed . "Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: Differences in obliteration rates, treatment-obliteration intervals, and prognostic factors". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20793364,
title = {Gamma Knife radiosurgery for cerebral arteriovenous malformations in children/adolescents and adults. Part II: Differences in obliteration rates, treatment-obliteration intervals, and prognostic factors},
author = {Nicolato, Antonio and Lupidi, Francesco and Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona and Sandri, Marco F. Dr. Econom. and Foroni, Roberto and Section of Sterotactic and Functional Neurosurgery, University of Verona and University Hospital, Verona and Zampieri, Piergiuseppe and Section of Neuroradiology, University of Verona and University Hospital, Verona and Mazza, Carlo and Section of Pediatric Neurosurgery, University of Verona and University Hospital, Verona and Pasqualin, Alberto and Neurosurgical Clinic, University of Verona and University Hospital, Verona and Beltramello, Alberto and Section of Neuroradiology, University of Verona and University Hospital, Verona and Gerosa, Massimo and Neurosurgical Clinic, University of Verona and University Hospital, Verona},
abstractNote = {Purpose: To evaluate and compare obliteration rates (OBRs) and treatment-obliteration intervals (TOIs) for cerebral arteriovenous malformations (cAVMs) treated with Gamma Knife radiosurgery in children/adolescents and adults; and to determine factors predicting the OBR and TOI in these two populations. Methods and Materials: This study concerned 62 children/adolescents and 193 adults observed for {>=}3 years. Fisher exact two-tailed and Wilcoxon rank-sum tests, multiple logistics, and Cox proportional hazard models were used for statistical analysis. Results: The overall OBR was 85.5% in children/adolescents and 87.6% in adults (p 0.671), but children/adolescents showed higher 36-month actuarial OBRs (69.35%) and shorter median TOIs (25.7 months) than adults (66.84% and 28.2 months; p 0.006 and p = 0.017, respectively). In children/adolescents, lower Spetzler-Martin grades (p = 0.043) and younger age (p = 0.019) correlated significantly with OBRs, and lower Spetzler-Martin grades (p 0.024) and noneloquent cAVM locations (p = 0.046) with TOIs. In adults, low flow through the cAVM and <6.2-cm{sup 3} volume were associated with both OBR and TOI (p 0.012 and p = 0.002, respectively). Conclusions: The differences in OBRs within 3 years and TOIs, although slight, seem to show that pediatric cAVMs behave differently from those in adults after Gamma Knife radiosurgery.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 64,
place = {United States},
year = {Wed Mar 01 00:00:00 EST 2006},
month = {Wed Mar 01 00:00:00 EST 2006}
}
  • Purpose: To compare the epidemiologic, morphologic, and clinical characteristics of 92 children/adolescents (Group A) and 362 adults (Group B) with cerebral arteriovenous malformations (cAVMs) considered suitable for radiosurgery; to correlate radiosurgery-related permanent complication and post-radiosurgery bleeding rates in the 75 children/adolescents and 297 adults available for follow-up. Methods and Materials: Radiosurgery was performed with a model C 201-source Co{sup 6} Leksell Gamma Unit (Elekta Instruments, Stockholm, Sweden). Fisher exact two-tailed, Wilcoxon rank-sum, and two-sample binomial exact tests were used for statistical analysis. Results: There were significant differences between the two populations in sex (p = 0.015), clinical presentation (p =more » 0.001), and location (p = 0.008). The permanent complication rate was lower in younger (1.3%) than in older patients (5.4%), although the difference was not significant (p = 0.213). The postradiosurgery bleeding rate was lower in Group A (1.3%) than in Group B (2.7%) (p = 0.694), with global actuarial bleeding rates of 0.56% per year and 1.15% per year, respectively. Conclusions: The different characteristics of child/adolescent and adult cAVMs suggest that they should be considered two distinct vascular disorders. The similar rates of radiosurgery-related complications and latency period bleeding in the two populations show that gamma knife radiosurgery does not expose young patients to a higher risk of sequelae than that for older patients.« less
  • Purpose: We investigate patient outcome, risk of hemorrhage, and factors affecting obliteration after LINAC-based radiosurgery (RS) for cerebral arteriovenous malformations (AVM) treated after partial embolization. Methods and Materials: This analysis is based on 50 patients treated after prior embolization. According to the Spetzler-Martin criteria the AVM classification was as follows: 9 patients, Grade I (18%); 19, Grade II (38%); 18, Grade III (36%); and 4, Grade IV (8%). Median RS-based AVM score was 1.41. Median single dose was 18 Gy/ 80% isodose (range, 15-22 Gy) and median AVM volume was 4.0 cc (range, 0.2-22.6 cc). In all, 34 patients (68%)more » experienced hemorrhage before RS. Median follow-up was 3.1 year (range, 8.5 months to 15 years). Results: Actuarial complete obliteration rate was 67% after 3 years and 78% after 4 years. The complete obliteration rate was significantly higher in AVM <3 cm (92% vs. 60%, p < 0.01) and in AVM Spetzler-Martin Grade I/II (90% vs. 59%, p < 0,01). Intracranial hemorrhage after RS was seen in 6 patients (12%) after 8.5 months median. Annual bleeding risk was 7.9% after 1 year and 2.2% after 2 years. It was found that AVM diameter {>=}3 cm (p < 0.006), AVM volume {>=}4 cc (p < 0.01), AVM score {>=}1.5 (p < 0.03), and single dose <18 Gy (p < 0.03) were associated with a significant higher bleeding risk. Conclusions: The rate of obliteration after RS in AVM treated after prior partial embolization depends on size as well as Spetzler-Martin grade. The risk of intracranial hemorrhage is not increased after RS and depends on AVM score, size, and volume, as well as on applied single dose.« less
  • Purpose: We evaluate patient-, angioma-, and treatment-specific factors for successful obliteration of cerebral arteriovenous malformations (AVM) to develop a new appropriate score to predict patient outcome after linac-based radiosurgery (RS). Methods and Materials: This analysis in based on 293 patients with cerebral AVM. Mean age at treatment was 38.8 years (4-73 years). AVM classification according Spetzler-Martin was 55 patients Grade I (20.5%), 114 Grade II (42.5%), 79 Grade III (29.5%), 19 Grade IV (7.1%), and 1 Grade V (0.4%). Median maximum AVM diameter was 3.0 cm (range, 0.3-10 cm). Median dose prescribed to the 80% isodose was 18 Gy (range,more » 12-22 Gy). Eighty-five patients (29.1%) had prior partial embolization; 141 patients (51.9%) experienced intracranial hemorrhage before RS. Median follow-up was 4.2 years. Results: Age at treatment, maximum diameter, nidus volume, and applied dose were significant factors for successful obliteration. Under presumption of proportional hazard in the dose range between 12 and 22 Gy/80% isodose, an increase of obliteration rate of approximately 25% per Gy was seen. On the basis of multivariate analysis, a prediction score was calculated including AVM maximum diameter and age at treatment. The prediction error up to the time point 8 years was 0.173 for the Heidelberg score compared with the Kaplan-Meier value of 0.192. An increase of the score of 1 point results in a decrease of obliteration chance by a factor of 0.447. Conclusion: The proposed score is linac-based radiosurgery-specific and easy to handle to predict patient outcome. Further validation on an independent patient cohort is necessary.« less
  • Short communication.
  • Purpose: The purpose of this investigation was to compare the accuracy of using internal anatomic landmarks instead of surgically implanted fiducials in the image registration process for volume-staged gamma knife (GK) radiosurgery for large arteriovenous malformations. Methods and Materials: We studied 9 patients who had undergone 10 staged GK sessions for large arteriovenous malformations. Each patient had fiducials surgically implanted in the outer table of the skull at the first GK treatment. These markers were imaged on orthogonal radiographs, which were scanned into the GK planning system. For the same patients, 8-10 pairs of internal landmarks were retrospectively identified onmore » the three-dimensional time-of-flight magnetic resonance imaging studies that had been obtained for treatment. The coordinate transformation between the stereotactic frame space for subsequent treatment sessions was then determined by point matching, using four surgically embedded fiducials and then using four pairs of internal anatomic landmarks. In both cases, the transformation was ascertained by minimizing the chi-square difference between the actual and the transformed coordinates. Both transformations were then evaluated using the remaining four to six pairs of internal landmarks as the test points. Results: Averaged over all treatment sessions, the root mean square discrepancy between the coordinates of the transformed and actual test points was 1.2 {+-} 0.2 mm using internal landmarks and 1.7 {+-} 0.4 mm using the surgically implanted fiducials. Conclusion: The results of this study have shown that using internal landmarks to determine the coordinate transformation between subsequent magnetic resonance imaging scans for volume-staged GK arteriovenous malformation treatment sessions is as accurate as using surgically implanted fiducials and avoids an invasive procedure.« less