TY - JOUR
T1 - Third Stereotactic Radiosurgery for Residual Arteriovenous Malformations
T2 - A Retrospective Multicenter Study
AU - Pikis, Stylianos
AU - Mantziaris, Georgios
AU - Dumot, Chloe
AU - Shaaban, Ahmed
AU - Protopapa, Maria
AU - Xu, Zhiyuan
AU - Niranjan, Ajay
AU - Wei, Zhishuo
AU - Srinivasan, Priyanka
AU - Tang, Lilly W.
AU - Liscak, Roman
AU - May, Jaromir
AU - Moreno, Nuria Martinez
AU - Álvarez, Roberto Martinez
AU - Peker, Selcuk
AU - Samanci, Yavuz
AU - Nabeel, Ahmed M.
AU - Reda, Wael A.
AU - Tawadros, Sameh R.
AU - Abdelkarim, Khaled
AU - El-Shehaby, Amr M.N.
AU - Emad, Reem M.
AU - Elazzazi, Ahmed Hesham
AU - Padmanaban, Varun
AU - Jareczek, Francis J.
AU - McInerney, James
AU - Cockroft, Kevin M.
AU - Lunsford, Dade
AU - Sheehan, Jason P.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/6/1
Y1 - 2024/6/1
N2 - BACKGROUND AND OBJECTIVES:There are no studies evaluating the efficacy and safety of more than 2 stereotactic radiosurgery (SRS) procedures for cerebral arteriovenous malformations (AVM). The aim of this study was to provide evidence on the role of third single-session SRS for AVM residual.METHODS:This multicenter, retrospective study included patients managed with a third single-session SRS procedure for an AVM residual. The primary study outcome was defined as AVM nidus obliteration without AVM bleeding or symptomatic radiation-induced changes (RIC). Secondary outcomes evaluated were AVM obliteration, AVM hemorrhage, asymptomatic, and symptomatic RIC.RESULTS:Thirty-eight patients (20/38 [52.6%] females, median age at third SRS 34.5 [IQR 20] years) were included. The median clinical follow-up was 46 (IQR 14.8) months, and 17/38 (44.7%) patients achieved favorable outcome. The 3-year and 5-year cumulative probability rates of favorable outcome were 23% (95% CI = 10%-38%) and 53% (95% CI = 29%-73%), respectively. The cumulative probability of AVM obliteration at 3 and 5 years after the third SRS was 23% (95% CI = 10%-37%) and 54% (95% CI = 29%-74%), respectively. AVM bleeding occurred in 2 patients, and 1 of them underwent subsequent resection. The cumulative probability rate of post-SRS AVM hemorrhage remained constant at 5.3% (95% CI = 1%-16%) during the first 5 years of follow-up. Transient symptomatic RIC managed conservatively occurred in 5/38 patients (13.2%) at a median time of 12.5 (IQR 22.5) months from third SRS. Radiation-induced cyst formation was noted in 1 patient (4.2%) 19 months post-SRS. No mortality, radiation-associated malignancy, or permanent symptomatic RIC was noted during follow-up.CONCLUSION:A third single-session SRS to treat a residual intracranial AVM offers obliteration in most patients. The risk of RIC was low, and these effects were transient. While not often required, a third SRS can be performed in patients with persistent residual AVMs.
AB - BACKGROUND AND OBJECTIVES:There are no studies evaluating the efficacy and safety of more than 2 stereotactic radiosurgery (SRS) procedures for cerebral arteriovenous malformations (AVM). The aim of this study was to provide evidence on the role of third single-session SRS for AVM residual.METHODS:This multicenter, retrospective study included patients managed with a third single-session SRS procedure for an AVM residual. The primary study outcome was defined as AVM nidus obliteration without AVM bleeding or symptomatic radiation-induced changes (RIC). Secondary outcomes evaluated were AVM obliteration, AVM hemorrhage, asymptomatic, and symptomatic RIC.RESULTS:Thirty-eight patients (20/38 [52.6%] females, median age at third SRS 34.5 [IQR 20] years) were included. The median clinical follow-up was 46 (IQR 14.8) months, and 17/38 (44.7%) patients achieved favorable outcome. The 3-year and 5-year cumulative probability rates of favorable outcome were 23% (95% CI = 10%-38%) and 53% (95% CI = 29%-73%), respectively. The cumulative probability of AVM obliteration at 3 and 5 years after the third SRS was 23% (95% CI = 10%-37%) and 54% (95% CI = 29%-74%), respectively. AVM bleeding occurred in 2 patients, and 1 of them underwent subsequent resection. The cumulative probability rate of post-SRS AVM hemorrhage remained constant at 5.3% (95% CI = 1%-16%) during the first 5 years of follow-up. Transient symptomatic RIC managed conservatively occurred in 5/38 patients (13.2%) at a median time of 12.5 (IQR 22.5) months from third SRS. Radiation-induced cyst formation was noted in 1 patient (4.2%) 19 months post-SRS. No mortality, radiation-associated malignancy, or permanent symptomatic RIC was noted during follow-up.CONCLUSION:A third single-session SRS to treat a residual intracranial AVM offers obliteration in most patients. The risk of RIC was low, and these effects were transient. While not often required, a third SRS can be performed in patients with persistent residual AVMs.
UR - https://www.scopus.com/pages/publications/105014944900
UR - https://www.scopus.com/pages/publications/105014944900#tab=citedBy
U2 - 10.1227/neu.0000000000002805
DO - 10.1227/neu.0000000000002805
M3 - Article
C2 - 38108313
AN - SCOPUS:105014944900
SN - 0148-396X
VL - 94
SP - 1174
EP - 1182
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -