TY - JOUR
T1 - Effect of cerebral arteriovenous malformation location on outcomes of repeat, single-fraction stereotactic radiosurgery
T2 - a matched-cohort analysis
AU - Mantziaris, Georgios
AU - Pikis, Stylianos
AU - Dumot, Chloe
AU - Dayawansa, Sam
AU - Liscak, Roman
AU - May, Jaromir
AU - Lee, Cheng Chia
AU - Yang, Huai Che
AU - Moreno, Nuria Martínez
AU - Álvarez, Roberto Martinez
AU - Dade Lunsford, L.
AU - Niranjan, Ajay
AU - Wei, Zhishuo
AU - Srinivasan, Priyanka
AU - Tang, Lilly W.
AU - Nabeel, Ahmed M.
AU - Reda, Wael A.
AU - Tawadros, Sameh R.
AU - Karim, Khaled Abdel
AU - El-Shehaby, Amr M.N.
AU - Emad Eldin, Reem M.
AU - Elazzazi, Ahmed Hesham
AU - Peker, Selcuk
AU - Samanci, Yavuz
AU - Padmanaban, Varun
AU - Jareczek, Francis J.
AU - McInerney, James
AU - Cockroft, Kevin M.
AU - Mathieu, David
AU - Aldakhil, Salman
AU - Alzate, Juan Diego
AU - Kondziolka, Douglas
AU - Tripathi, Manjul
AU - Palmer, Joshua D.
AU - Upadhyay, Rituraj
AU - Lin, Michelle
AU - Zada, Gabriel
AU - Yu, Cheng
AU - Cifarelli, Christopher P.
AU - Cifarelli, Daniel T.
AU - Shaaban, Ahmed
AU - Xu, Zhiyuan
AU - Sheehan, Jason P.
N1 - Publisher Copyright:
© AANS 2024.
PY - 2024/6
Y1 - 2024/6
N2 - OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes. METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose. RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference −18%, 95% CI −30.9 to −5.8%, p = 0.004) and AVM obliteration (probability difference –18%, 95% CI –30.1% to −6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI –2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI –10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047). CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.
AB - OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes. METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose. RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference −18%, 95% CI −30.9 to −5.8%, p = 0.004) and AVM obliteration (probability difference –18%, 95% CI –30.1% to −6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI –2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI –10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047). CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.
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U2 - 10.3171/2023.10.JNS231957
DO - 10.3171/2023.10.JNS231957
M3 - Article
C2 - 38134430
AN - SCOPUS:85195227532
SN - 0022-3085
VL - 140
SP - 1753
EP - 1761
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 6
ER -