1
|
Mooney J, Salehani A, Erickson N, Thomas E, Ilyas A, Rahm S, Eustace N, Maleknia P, Yousuf O, Bredel M, Fiveash J, Dobelbower C, Fisher W. Stereotactic radiosurgery for ruptured versus unruptured intracranial arteriovenous malformations. Surg Neurol Int 2022; 13:194. [PMID: 35673645 PMCID: PMC9168326 DOI: 10.25259/sni_86_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
There are a limited data examining the effects of prior hemorrhage on outcomes after stereotactic radiosurgery (SRS). The goal of this study was to identify risk factors for arteriovenous malformation (AVM) rupture and compare outcomes, including post-SRS hemorrhage, between patients presenting with ruptured and unruptured AVMs.
Methods:
A retrospective review of consecutive patients undergoing SRS for intracranial AVMs between 2009 and 2019 at our institution was conducted. Chi-square and multivariable logistic regression analyses were utilized to identify patient and AVM factors associated with AVM rupture at presentation and outcomes after SRS including the development of recurrent hemorrhage in both ruptured and unruptured groups.
Results:
Of 210 consecutive patients with intracranial AVMs treated with SRS, 73 patients (34.8%) presented with AVM rupture. Factors associated with AVM rupture included smaller AVM diameter, deep venous drainage, cerebellar location, and the presence of intranidal aneurysms (P < 0.05). In 188 patients with adequate follow-up time (mean 42.7 months), the overall post-SRS hemorrhage rate was 8.5% and was not significantly different between ruptured and unruptured groups (10.3 vs. 7.5%, P = 0.51). There were no significant differences in obliteration rate, time to obliteration, or adverse effects requiring surgery or steroids between unruptured and ruptured groups.
Conclusion:
Smaller AVM size, deep venous drainage, and associated intranidal aneurysms were associated with rupture at presentation. AVM rupture at presentation was not associated with an increased risk of recurrent hemorrhage or other complication after SRS when compared to unruptured AVM presentation. Obliteration rates were similar between ruptured and unruptured groups.
Collapse
Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Evan Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Nicholas Eustace
- Department of School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Pedram Maleknia
- Department of School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Omer Yousuf
- Department of School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Chris Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Winfield Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| |
Collapse
|
2
|
Erickson N, Mooney J, Salehani A, Thomas E, Ilyas A, Rahm S, Maleknia P, Yousuf O, Fiveash J, Dobelbower C, Fisher WS. Predictive Factors for AVM Obliteration after Stereotactic Radiosurgery: A Single Center Study. World Neurosurg 2022; 160:e529-e536. [PMID: 35077887 DOI: 10.1016/j.wneu.2022.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND SRS is particularly useful for deep AVMs in eloquent territory with a high associated surgical risk. Prior studies have demonstrated high rates of AVM obliteration with SRS typically ranging 60-80% in a latency period of 2-4 years for complete obliteration. Studies have identified several factors associated with successful obliteration of the AVM nidus, however, these present inconsistent and conflicting data. OBJECTIVE To present a single center study examining factors associated with successful obliteration of AVMs treated with SRS. METHODS We performed a retrospective review of 210 consecutive patients undergoing SRS for brain AVMs between 2010 and 2019 at our institution. Chi square and logistic regression analyses were utilized to identify patient and AVM factors associated with successful obliteration. RESULTS Younger age (p=0.034) and prior embolization (p=0.012) were associated with complete obliteration. Figure 2 demonstrates survival curves for those with complete obliteration comparing those with prior embolization (n = 6) to those without prior embolization (n = 182). The presence of coronary artery disease (CAD) was associated with incomplete obliteration (p=0.04). There were no AVM characteristics statistically associated with complete obliteration although superficial venous drainage (p=0.08) and frontal location (p=0.06) trended towards significance. CONCLUSIONS Successful obliteration of the AVM nidus was significantly associated with younger age and prior embolization. The presence of coronary artery disease negatively affected obliteration rates. These results add to the mixed results seen in the literature and emphasize the need for continued studies to delineate more specific patient and AVM factors that contribute to successful obliteration.
Collapse
Affiliation(s)
- Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA.
| | - James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Evan Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, AL, USA
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Pedram Maleknia
- School of Medicine, University of Alabama at Birmingham, AL, USA
| | - Omer Yousuf
- School of Medicine, University of Alabama at Birmingham, AL, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, AL, USA
| | - Chris Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, AL, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| |
Collapse
|
3
|
Mooney J, Erickson N, Salehani A, Thomas E, Ilyas A, Rahm S, Eustace N, Maleknia P, Yousuf O, Saccomano B, Bredel M, Fiveash J, Dobelbower C, Fisher WS. Seizure Rates After Stereotactic Radiosurgery for Cerebral AVMs: A Single Center Study. World Neurosurg 2021; 158:e583-e591. [PMID: 34775089 DOI: 10.1016/j.wneu.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Seizure control after stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) is an area of growing interest, with previous studies reporting up to 70% seizure freedom after treatment. The goals of this study were to identify specific patient and AVM characteristics associated with seizure presentation and seizure outcomes after SRS treatment. METHODS A retrospective review of consecutive patients undergoing SRS for brain AVMs between 2009 and 2019 at our institution was conducted. Chi-squared and logistic regression analyses were utilized to identify patient and AVM factors associated with preoperative seizure presentation and development of new onset seizures after SRS. RESULTS Two hundred ten consecutive patients presenting with AVMs treated with SRS were reviewed. Factors associated with seizure presentation included larger AVM size (P = 0.02), superficial venous drainage (P < 0.05), and parietal location (P = 0.04). Of 188 patients with follow-up (90%), 30 patients presented with seizures and 14 (47%) were seizure-free post-SRS. Of 158 patients presenting without seizure, 29 (18%) developed de novo seizures during follow-up. De novo post-SRS seizures were associated with prior craniotomy for resection of AVM (P = 0.04), post-treatment hemorrhage (P = 0.02), parietal location (P = 0.05), adverse effect requiring steroids (P < 0.01), and adverse effect requiring surgery (P < 0.01). CONCLUSIONS Seizures are a common presentation of brain AVMs and can be treated effectively with SRS. However, seizures can also be a complication of SRS and are associated with post-treatment hemorrhage, edema, and need for future open surgery.
Collapse
Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA.
| | - Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Evan Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Nicholas Eustace
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Pedram Maleknia
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Omer Yousuf
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Ben Saccomano
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - Chris Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| |
Collapse
|