Stereotactic radiosurgery for cerebellar arteriovenous malformations: an international multicenter study
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- Or Cohen-Inbar
- Department of Neurosurgery and Gamma-Knife Center, University of Virginia Health System, Charlottesville, Virginia;
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- Robert M. Starke
- Department of Neurosurgery and Gamma-Knife Center, University of Virginia Health System, Charlottesville, Virginia;
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- Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh, Pennsylvania;
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- Gregory Bowden
- Department of Neurosurgery, University of Pittsburgh, Pennsylvania;
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- Paul Huang
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York;
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- Rafael Rodriguez-Mercado
- Department of Neurosurgery, University of Puerto Rico, San Juan, Puerto Rico;
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- Luis Almodovar
- Department of Neurosurgery, University of Puerto Rico, San Juan, Puerto Rico;
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- Inga S. Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan;
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- David Mathieu
- Department of Neurosurgery, University of Sherbrooke, Centre de Recherche Clinique Étienne-LeBel, Sherbrooke, Quebec, Canada;
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- Danilo Silva
- Rose-Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio;
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- Mahmoud Abbassy
- Rose-Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio;
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- Symeon Missios
- Rose-Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio;
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- John Y. K. Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
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- Gene H. Barnett
- Rose-Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio;
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- Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York;
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- L. Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pennsylvania;
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- Jason P. Sheehan
- Department of Neurosurgery and Gamma-Knife Center, University of Virginia Health System, Charlottesville, Virginia;
説明
<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Cerebellar arteriovenous malformations (AVMs) represent the majority of infratentorial AVMs and frequently have a hemorrhagic presentation. In this multicenter study, the authors review outcomes of cerebellar AVMs after stereotactic radiosurgery (SRS).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Eight medical centers contributed data from 162 patients with cerebellar AVMs managed with SRS. Of these patients, 65% presented with hemorrhage. The median maximal nidus diameter was 2 cm. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent radiation-induced complications (RICs). Patients were followed clinically and radiographically, with a median follow-up of 60 months (range 7–325 months).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The overall actuarial rates of obliteration at 3, 5, 7, and 10 years were 38.3%, 74.2%, 81.4%, and 86.1%, respectively, after single-session SRS. Obliteration and a favorable outcome were more likely to be achieved in patients treated with a margin dose greater than 18 Gy (p < 0.001 for both), demonstrating significantly better rates (83.3% and 79%, respectively). The rate of latency preobliteration hemorrhage was 0.85%/year. Symptomatic post-SRS RICs developed in 4.5% of patients (n = 7). Predictors of a favorable outcome were a smaller nidus (p = 0.0001), no pre-SRS embolization (p = 0.003), no prior hemorrhage (p = 0.0001), a higher margin dose (p = 0.0001), and a higher maximal dose (p = 0.009). The Spetzler-Martin grade was not found to be predictive of outcome. The Virginia Radiosurgery AVM Scale score (p = 0.0001) and the Radiosurgery-Based AVM Scale score (p = 0.0001) were predictive of a favorable outcome.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>SRS results in successful obliteration and a favorable outcome in the majority of patients with cerebellar AVMs. Most patients will require a nidus dose of higher than 18 Gy to achieve these goals. Radiosurgical and not microsurgical scales were predictive of clinical outcome after SRS.</jats:p></jats:sec>
収録刊行物
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- Journal of Neurosurgery
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Journal of Neurosurgery 127 (3), 512-521, 2017-09
Journal of Neurosurgery Publishing Group (JNSPG)