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Outcomes of stereotactic radiosurgery for hemorrhagic arteriovenous malformations with or without prior resection or embolization
- Source :
- Journal of Neurosurgery. 135:733-741
- Publication Year :
- 2021
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2021.
-
Abstract
- OBJECTIVE The major concern about ruptured arteriovenous malformations (rAVMs) is recurrent hemorrhage, which tends to preclude stereotactic radiosurgery (SRS) as a therapeutic modality for these brain malformations. In this study, the authors aimed to clarify the role of SRS for rAVM as a stand-alone modality and an adjunct for a remnant nidus after surgery or embolization. METHODS Data on 410 consecutive patients with rAVMs treated with SRS were analyzed. The patients were classified into groups, according to prior interventions: SRS-alone, surgery and SRS (Surg-SRS), and embolization and SRS (Embol-SRS) groups. The outcomes of the SRS-alone group were analyzed in comparison with those of the other two groups. RESULTS The obliteration rate was higher in the Surg-SRS group than in the SRS-alone group (5-year cumulative rate 97% vs 79%, p < 0.001), whereas no significant difference was observed between the Embol-SRS and SRS-alone groups. Prior resection (HR 1.78, 95% CI 1.30–2.43, p < 0.001), a maximum AVM diameter ≤ 20 mm (HR 1.81, 95% CI 1.43–2.30, p < 0.001), and a prescription dose ≥ 20 Gy (HR 2.04, 95% CI 1.28–3.27, p = 0.003) were associated with a better obliteration rate, as demonstrated by multivariate Cox proportional hazards analyses. In the SRS-alone group, the annual post-SRS hemorrhage rates were 1.5% within 5 years and 0.2% thereafter and the 10-year significant neurological event–free rate was 95%; no intergroup difference was observed in either outcome. The exclusive performance of SRS (SRS alone) was not a risk for post-SRS hemorrhage or for significant neurological events based on multivariate analyses. These results were also confirmed with propensity score–matched analyses. CONCLUSIONS The treatment strategy for rAVMs should be tailored with due consideration of multiple factors associated with the patients. Stand-alone SRS is effective for hemorrhagic AVMs, and the risk of post-SRS hemorrhage was low. SRS can also be favorably used for residual AVMs after initial interventions, especially after failed resection.
- Subjects :
- medicine.medical_specialty
Multivariate analysis
Proportional hazards model
business.industry
medicine.medical_treatment
Significant difference
General Medicine
Radiosurgery
Resection
03 medical and health sciences
0302 clinical medicine
Multiple factors
030220 oncology & carcinogenesis
parasitic diseases
medicine
Radiology
Embolization
business
030217 neurology & neurosurgery
Recurrent hemorrhage
Subjects
Details
- ISSN :
- 19330693 and 00223085
- Volume :
- 135
- Database :
- OpenAIRE
- Journal :
- Journal of Neurosurgery
- Accession number :
- edsair.doi.dedup.....3e9623e57b222c0f284aae87b9fea6e8