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Effect of Advanced Age on Stereotactic Radiosurgery Outcomes for Brain Arteriovenous Malformations: A Multicenter Matched Cohort Study
- Source :
- World neurosurgery. 119
- Publication Year :
- 2018
-
Abstract
- Background The effect of age on adult brain arteriovenous malformation (AVM) outcomes after stereotactic radiosurgery (SRS) remains unclear. The aim of this study is to compare AVM outcomes between elderly (age ≥60 years) and nonelderly adult patients. Methods We retrospectively reviewed pooled data comprising patients who underwent SRS for AVMs between 1987 and 2014 at 8 centers participating in the International Gamma Knife Research Foundation. Adult (age ≥18 years) patients with ≥12 months follow-up were dichotomized into elderly and nonelderly cohorts, and matched in a 1:1 ratio. Favorable outcome was AVM obliteration without permanent symptomatic radiation-induced changes (RIC) or post-SRS hemorrhage. Results The study cohort consisted of 1845 patients (188 elderly vs. 1657 nonelderly) who met the inclusion criteria, and subsequent matching resulted in 181 patients in each cohort. In the matched cohorts, rates of obliteration (54.7% vs. 64.6%; P = 0.054) favorable outcome (51.4% vs. 61.3%; P = 0.056) were no different between the elderly and nonelderly cohorts. The rates of post-SRS hemorrhage (9.9% vs. 5.5%; P = 0.115), RIC (26.5% vs. 30.9%; P = 0.353), symptomatic RIC (9.4% vs. 9.4%; P = 1.000), and permanent symptomatic RIC (3.3% vs. 2.2%; P = 0.750) were also not significantly different between the elderly and nonelderly cohorts. Elderly patients with AVM did have a significantly higher rate of all-cause mortality (27.7% vs. 5.5%; P Conclusions Advanced age does not seem to significantly affect obliteration or complication rates after SRS for AVMs. Although the decision to recommend intervention for AVMs in the elderly population is multifactorial, SRS may be a viable modality when treatment is deemed appropriate.
- Subjects :
- Adult
Intracranial Arteriovenous Malformations
Male
Pediatrics
medicine.medical_specialty
medicine.medical_treatment
Gamma knife
Radiosurgery
03 medical and health sciences
0302 clinical medicine
Matched cohort
Elderly population
Medicine
Humans
Pooled data
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Age Factors
Arteriovenous malformation
Middle Aged
medicine.disease
Treatment Outcome
030220 oncology & carcinogenesis
Cohort
Surgery
Female
Neurology (clinical)
business
Complication
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 119
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....36b88bdd8051205f5ae59afc80cc17ef