Radiosurgery for unruptured brain arteriovenous malformations: An international multicenter retrospective cohort study

Dale Ding, Robert M. Starke, Hideyuki Kano, John Y.K. Lee, David Mathieu, John Pierce, Paul Huang, Symeon Missios, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Douglas Kondziolka, Gene H. Barnett, L. Dade Lunsford, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: The role of intervention in the management of unruptured brain arteriovenous malformations (AVM) is controversial. Objective: To analyze in a multicenter, retrospective cohort study, the outcomes following radiosurgery for unruptured AVMs and determine predictive factors. Methods: We evaluated and pooled AVM radiosurgery data from 8 institutions participating in the International Gamma Knife Research Foundation. Patients with unruptured AVMs and ≥12 mo of follow-up were included in the study cohort. Favorable outcome was defined as AVM obliteration, no postradiosurgical hemorrhage, and no permanently symptomatic radiation-induced changes. Results: The unruptured AVM cohort comprised 938 patients with a median age of 35 yr. The median nidus volume was 2.4 cm3, 71% of AVMs were located in eloquent brain areas, and the Spetzler-Martin grade was III or higher in 57%. The median radiosurgical margin dose was 21 Gy and follow-up was 71 mo. AVM obliteration was achieved in 65%. The annual postradiosurgery hemorrhage rate was 1.4%. Symptomatic and permanent radiation-induced changes occurred in 9% and 3%, respectively. Favorable outcome was achieved in 61%. In the multivariate logistic regression analysis, smaller AVM maximum diameter (P = .001), the absence of AVM-associated arterial aneurysms (P = .001), and higher margin dose (P = .002) were found to be independent predictors of a favorable outcome. A margin dose ≥ 20 Gy yielded a significantly higher rate of favorable outcome (70% vs 36%; P < .001) Conclusion: Radiosurgery affords an acceptable risk to benefit profile for patients harboring unruptured AVMs. These findings justify further prospective studies comparing radiosurgical intervention to conservative management for unruptured AVMs.

Original languageEnglish (US)
Pages (from-to)888-898
Number of pages11
JournalClinical Neurosurgery
Volume80
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Keywords

  • Gamma knife
  • Intracranial arteriovenous malformation
  • Intracranial hemorrhages
  • Radiosurgery
  • Stroke
  • Vascular malformations

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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