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Gamma Knife surgical treatment for partially embolized cerebral arteriovenous malformations

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机构: [1]Capital Med Univ, Dept Intervent Neuroradiol, Beijing Neurosurg Inst, Beijing, Peoples R China; [2]Capital Med Univ, Beijing Tiantan Hosp, Beijing, Peoples R China; [3]Beijing Neurosurg Inst, 6 Tiantan Xili, Beijing 100050, Peoples R China
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关键词: cerebral arteriovenous malformation endovascular embolization Gamma Knife surgery stereotactic radiosurgery vascular disorders

摘要:
OBJECTIVE A combination of embolization and radiosurgery is used as a common strategy for the treatment of large and complex cerebral arteriovenous malformations (AVMs). This study presents the experiences of partially embolized cerebral AVMs followed by Gamma Knife surgery (GKS) and assesses predictive factors for AVM obliteration and hemorrhage. METHODS The interventional neuroradiology database that was reviewed included 404 patients who underwent AVM embolization. Using this database, the authors retrospectively analyzed all partially embolized AVM cases followed by GKS for a residual nidus. Except for cases of complete AVM obliteration, the authors excluded all patients with radiological follow-up of less than 2 years. Logistic regression analysis was used to analyze the predictive factors related to AVM obliteration and hemorrhage following GKS. Kaplan-Meier analysis was used to evaluate the obliteration with a cutoff AVM nidus volume of 3 cm(3) and 10 cm(3). RESULTS One hundred sixty-two patients qualified for the study. The median patient age was 26 years and 48.8% were female. Hemorrhage presented as the most common symptom (48.1%). The median preembolization volume of an AVM was 14.3 cm(3). The median volume and margin dose for GKS were 10.92 cm(3) and 16.0 Gy, respectively. The median radiological and clinical follow-up intervals were 47 and 79 months, respectively. The annual hemorrhage rate was 1.71% and total obliteration rate was 56.8%. Noneloquent area (p = 0.004), superficial location (p < 0.001), decreased volume (p < 0.001), lower Spetzler-Martin grade (p < 0.001), lower Virginia Radiosurgery AVM Scale (RAS; p < 0.001), lower Pollock-Flickinger score (p < 0.001), lower modified Pollock-Flickinger score (p < 0.001), increased maximum dose (p < 0.001), and increased margin dose (p < 0.001) were found to be statistically significant in predicting the probability of AVM obliteration in the univariate analysis. In the multivariate analysis, only volume (p = 0.016) was found to be an independent prognostic factor for AVM obliteration. The log-rank (Mantel-Cox) test of the Kaplan-Meier analysis (chi-square = 54.402, p < 0.001) showed a significantly decreased obliteration rate of different cutoff AVM volume groups of less than 3 cm(3), 3-10 cm(3), and more than 10 cm(3). No independent prognostic factor was found for AVM hemorrhage in multivariate analysis. CONCLUSIONS Partially embolized AVMs are amenable to successful treatment with GKS. The volume of the nidus significantly influences the outcome of radiosurgical treatment. The Virginia RAS and Pollock-Flickinger score were found to be reliable scoring systems for selection of patient candidates and prediction of partially embolized AVM closure and complications for GKS.

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出版当年[2015]版:
大类 | 3 区 医学
小类 | 2 区 外科 3 区 临床神经病学
最新[2023]版:
大类 | 2 区 医学
小类 | 2 区 临床神经病学 2 区 外科
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出版当年[2014]版:
Q1 SURGERY Q1 CLINICAL NEUROLOGY
最新[2023]版:
Q1 CLINICAL NEUROLOGY Q1 SURGERY

影响因子: 最新[2023版] 最新五年平均 出版当年[2014版] 出版当年五年平均 出版前一年[2013版] 出版后一年[2015版]

第一作者:
第一作者机构: [1]Capital Med Univ, Dept Intervent Neuroradiol, Beijing Neurosurg Inst, Beijing, Peoples R China; [2]Capital Med Univ, Beijing Tiantan Hosp, Beijing, Peoples R China; [3]Beijing Neurosurg Inst, 6 Tiantan Xili, Beijing 100050, Peoples R China
通讯作者:
通讯机构: [1]Capital Med Univ, Dept Intervent Neuroradiol, Beijing Neurosurg Inst, Beijing, Peoples R China; [2]Capital Med Univ, Beijing Tiantan Hosp, Beijing, Peoples R China; [3]Beijing Neurosurg Inst, 6 Tiantan Xili, Beijing 100050, Peoples R China
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