Hypofractionated stereotactic radiosurgery for treatment of cerebral arteriovenous malformations: outcome analysis with use of the modified arteriovenous malformation scoring system |
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| Affiliation: | 1. Department of Neurological Surgery, Southern California Permanente Medical Group, 1505 N. Edgemont Street, 4th Floor, Los Angeles, CA 90027, USA;2. Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, CA, USA;3. Division of Neurointerventional Procedures, Department of Radiology, Southern California Permanente Medical Group, Los Angeles, CA, USA;1. University of Arizona, Department of Orthopaedic Surgery, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA;2. University of Arizona, Department of Surgery, Division of Neurosurgery, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA;3. University of Arizona, College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA;1. Department of Neurological Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #507, Little Rock, AR 72205, USA;2. New York University School of Medicine, New York, NY, USA;3. Department of Pediatric Neuro-oncology, New York University School of Medicine, New York, NY, USA;4. Department of Neuroradiology, New York University School of Medicine, New York, NY, USA;5. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;6. Department of Neuropathology, New York University School of Medicine, New York, NY, USA;1. Shandong Cancer Hospital and Institute, 440 Jiyan, Jinan 250117, Shandong Province, China;2. The Second Hospital of Shandong University, Shandong Province, China;3. Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China;1. Physiotherapy Department, Monash Health, Cheltenham, VIC, Australia;2. School of Psychological Sciences, Monash University, Clayton, VIC, Australia;3. Bruce Lefroy Centre, Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC 3052, Australia;4. Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, Australia;5. Department of Neurology, The Royal Children’s Hospital, Parkville, VIC, Australia;6. Clinical Genetics, Austin Health, Heidelberg, VIC, Australia;1. Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taiwan;2. Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, 201 Shih-Pai Road, Section 2, Taipei 11217, Taiwan;3. Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang-Ming University, Taiwan;4. Department of Otolaryngology – Head and Neck Surgery, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA |
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| Abstract: | Radiosurgery has long been an accepted modality for definitive treatment of cerebral arteriovenous malformations (AVM). Efforts to improve the therapeutic ratio for this indication include use of staged volume procedures and hypofractionation. This study reviews our experience with a cohort of patients treated with hypofractionated radiosurgery. Over a 3 year period, 38 patients harboring 39 cerebral AVM were treated with hypofractionated stereotactic radiotherapy. Seventeen of these patients presented due to hemorrhage, four were asymptomatic unruptured lesions and the remainder were symptomatic unruptured lesions. The median AVM volume was 11.43 cc and median modified Radiosurgery-Based Arteriovenous Malformation Score (mRBAS) was 2.02. The median follow-up was 7.32 years. Four patients harboring four AVM were lost to follow-up before a result could be ascertained leaving 35 AVM for analysis. Excellent outcomes (AVM obliteration without new deficits) occurred in 17 of 34 (50%) patients and in 18 of 35 (51%) AVM treated. AVM obliteration was seen in 26 of 35 (74%) lesions treated. Two patients died during the follow-up period (6%). A poor result (major deficit without obliteration) was seen in one patient. Of 19 patients harboring AVM with mRBAS >2.0, an excellent outcome was achieved in eight (42%). Hypofractionation for cerebral AVM can result in satisfactory obliteration rates, but with risk of significant complications commensurate with mRBAS. Further study of this technique will be needed to ascertain the degree of incremental improvement, if any, over other radiosurgery treatment methods. |
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| Keywords: | Arteriovenous malformation LINAC Hypofractionation Radiosurgery |
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