The Radiosurgical Treatment of Arteriovenous Malformations: Obliteration, Morbidities, and Performance Status

Journal Article · Wed Jun 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.01.049· OSTI ID:21491769

Sun, Daniel Q ^[1]; Carson, Kathryn A ^[2]; Raza, Shaan M; Batra, Sachin ^[1]; Kleinberg, Lawrence R ^[3]; Lim, Michael; Huang, Judy ^[1]; Rigamonti, Daniele ^[1]

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1. Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD (United States)
2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (United States)
3. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD (United States)

Objective: This study examined the single-center treatment outcomes of arteriovenous malformations (AVMs) of the brain using stereotactic radiosurgery, with regard to obliteration, predictive factors, morbidities, and patient performance status. Patients and Methods: 127 patients were treated between 1990 and 2008 by use of linear accelerator or Gamma Knife. Their median age was 37 years, the median AVM volume was 7.3 cc (range, 0.014-113.13 cc), and the median follow-up duration was 42 months (range, 6-209 months). Forty-two percent of patients presented with intracranial hemorrhage, 31% received embolization, and 8% underwent prior resection. Thirty-one percent of patients received more than one round of radiosurgery. Results: 64% of patients had complete obliteration confirmed by magnetic resonance imaging or angiography. Positive predictors of obliteration included pretreatment hemorrhage (p = 0.042), smaller AVM volume (odds ratio = 1.25; 95% CI, 1.03-1.52), and larger marginal dose (odds ratio = 0.292; 95% CI, 0.100-0.820), whereas embolization (p < 0.001) was a negative predictor . The annual risk of hemorrhage after radiosurgery was 2.2%, and the risk of death as a result of hemorrhage was 0.6-1.3%. Eleven percent of patients reported new or worsened neurologic symptoms. Radiosurgery was effective in treating AVM-related headaches (p < 0.001) but did not improve the performance status of patients. Conclusions: Stereotactic radiosurgery is an effective tool in the treatment of AVMs and amelioration of AVM-related headaches, but it did not affect the patients' performance status. Factors affecting obliteration include prior hemorrhage, marginal dose, prior embolization, and AVM volume. Risk of hemorrhage persists in the latency period after radiosurgery, and it remains finite even after complete obliteration.

• OSTI ID: 21491769
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
ACCELERATORS
BIOMEDICAL RADIOGRAPHY
BLOOD VESSELS
BODY
BRAIN
CARDIOVASCULAR SYSTEM
CENTRAL NERVOUS SYSTEM
DIAGNOSTIC TECHNIQUES
EMBOLI
HAZARDS
HEALTH HAZARDS
HEMORRHAGE
LINEAR ACCELERATORS
MALFORMATIONS
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NERVOUS SYSTEM
NMR IMAGING
NUCLEAR MEDICINE
ORGANS
PATHOLOGICAL CHANGES
RADIATION HAZARDS
RADIOLOGY
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SURGERY
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