Stereotactic Radiosurgery for Brain Arteriovenous Malformations: Evaluation of Obliteration and Review of Associated Predictors

Badih J Daou; Gregory Palmateer; B Gregory Thompson; Cormac O Maher; James A Hayman; Kwok L Lam; Daniel R Wahl; Michelle Kim; Aditya S Pandey

doi:10.1016/j.jstrokecerebrovasdis.2020.104863

Stereotactic Radiosurgery for Brain Arteriovenous Malformations: Evaluation of Obliteration and Review of Associated Predictors

J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104863. doi: 10.1016/j.jstrokecerebrovasdis.2020.104863. Epub 2020 Jun 8.

Authors

Badih J Daou¹, Gregory Palmateer², B Gregory Thompson³, Cormac O Maher⁴, James A Hayman⁵, Kwok L Lam⁶, Daniel R Wahl⁷, Michelle Kim⁸, Aditya S Pandey⁹

Affiliations

¹ Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
² Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
³ Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
⁴ Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
⁵ Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
⁶ Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
⁷ Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
⁸ Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
⁹ Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].

PMID: 32689634
DOI: 10.1016/j.jstrokecerebrovasdis.2020.104863

Abstract

Background: High arteriovenous malformation (AVM) obliteration rates have been reported with stereotactic radiosurgery (SRS), and multiple factors have been found to be associated with AVM obliteration. These predictors have been inconsistent throughout studies. We aimed to analyze our experience with linear accelerator (LINAC)-based SRS for brain AVMs, evaluate outcomes, assess factors associated with AVM obliteration and review the various reported predictors of AVM obliteration.

Methods: Electronic medical records were retrospectively reviewed to identify consecutive patients with brain AVMs treated with SRS over a 27-year period with at least 2 years of follow-up. Logistic regression analysis was performed to identify factors associated with AVM obliteration.

Results: One hundred twenty-eight patients with 142 brain AVMs treated with SRS were included. Mean age was 34.4 years. Fifty-two percent of AVMs were associated with a hemorrhage before SRS, and 14.8% were previously embolized. Mean clinical and angiographic follow-up times were 67.8 months and 58.6 months, respectively. The median Spetzler-Martin grade was 3. Mean maximal AVM diameter was 2.8 cm and mean AVM target volume was 7.4 cm³ with a median radiation dose of 16 Gy. Complete AVM obliteration was achieved in 80.3%. Radiation-related signs and symptoms were encountered in 32.4%, only 4.9% of which consisted of a permanent deficit. Post-SRS AVM-related hemorrhage occurred in 6.3% of cases. In multivariate analysis, factors associated with AVM obliteration included younger patient age (P = .019), male gender (P = .008), smaller AVM diameter (P = .04), smaller AVM target volume (P = .009), smaller isodose surface volume (P = .005), a higher delivered radiation dose (P = .013), and having only one major draining vein (P = .04).

Conclusions: AVM obliteration with LINAC-based radiosurgery was safe and effective and achieved complete AVM obliteration in about 80% of cases. The most prominent predictors of AVM success included AVM size, AVM volume, radiation dose, number of draining veins and patient age.

Keywords: AVM obliteration; Based radiosurgery; Brain arteriovenous malformation; Linear accelerator; Stereotactic radiosurgery.

MeSH terms

Adolescent
Adult
Aged
Arteriovenous Fistula / diagnostic imaging
Arteriovenous Fistula / physiopathology
Arteriovenous Fistula / radiotherapy*
Child
Child, Preschool
Electronic Health Records
Female
Humans
Intracranial Arteriovenous Malformations / diagnostic imaging
Intracranial Arteriovenous Malformations / physiopathology
Intracranial Arteriovenous Malformations / radiotherapy*
Male
Middle Aged
Radiation Dosage
Radiosurgery* / adverse effects
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult