Radiosurgery for Cerebral Arteriovenous Malformations in Elderly Patients: Effect of Advanced Age on Outcomes after Intervention

Dale Ding, Zhiyuan Xu, Chun Po Yen, Robert M. Starke, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Objective Cerebral arteriovenous malformations (AVM) are infrequently diagnosed and treated in elderly patients (age, >60 years). We hypothesize that, in contrast to AVM surgical outcomes, radiosurgery outcomes are not adversely affected by increased age. The goals of this case-control study are to analyze the radiosurgery outcomes for elderly patients with AVMs and determine the effect of elderly age on AVM radiosurgery outcomes. Methods We evaluated a prospective database of patients with AVMs treated with radiosurgery from 1989 to 2013. Elderly patients with AVM (age, 60 years) with radiologic follow-up of 2 years or nidus obliteration were selected for analysis, and matched, in a 1:1 fashion and blinded to outcome, to adult nonelderly patients with AVM (age, <60 years). Statistical analyses were performed to determine actuarial obliteration rates and evaluate the relationship between elderly age and AVM radiosurgery outcomes. Results The matching processes yielded 66 patients in each of the elderly and nonelderly AVM cohorts. In the elderly AVM cohort, the actuarial AVM obliteration rates at 3, 5, and 10 years were 37%, 65%, and 77%, respectively; the rates of radiologically evident, symptomatic, and permanent radiation-induced changes were 36%, 11%, and 0%, respectively; the annual hemorrhage risk after radiosurgery was 1.1%, and the AVM-related mortality rate was 1.5%. Elderly age was not significantly associated with AVM obliteration, radiation-induced changes, or hemorrhage after radiosurgery. Conclusions Advanced age does not appear to confer appreciably worse AVM radiosurgery outcomes, unlike its negative effect on AVM surgical outcomes. Thus, when an AVM warrants treatment, radiosurgery may be the preferred treatment for elderly patients.

Original languageEnglish (US)
Pages (from-to)795-804
Number of pages10
JournalWorld neurosurgery
Volume84
Issue number3
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Keywords

  • Age groups
  • Elderly
  • Gamma knife
  • Intracranial arteriovenous malformations
  • Radiosurgery
  • Stroke
  • Vascular malformations

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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