Linear Accelerator Stereotactic Radiosurgery of Central Nervous System Arteriovenous Malformations: A 15-Year Analysis of Outcome-Related Factors in a Single Tertiary Center
| Autor: | Pedro Martínez Cueto, Rosa María Martínez Rolán, José Luis Thenier-Villa, Adolfo Ramón De La Lama Zaragoza, Cesáreo Conde Alonso, Raúl Alejandro Galárraga-Campoverde, Manuel Salgado Fernández, Víctor Muñoz Garzón |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male medicine.medical_treatment Radiosurgery Magnetic resonance angiography 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans Cerebral Hemorrhage Retrospective Studies medicine.diagnostic_test Rupture Spontaneous business.industry Angiography Digital Subtraction Magnetic resonance imaging Retrospective cohort study Arteriovenous malformation Digital subtraction angiography Middle Aged medicine.disease Embolization Therapeutic Magnetic Resonance Imaging Cerebral Angiography Treatment Outcome 030220 oncology & carcinogenesis Surgery Female Neurology (clinical) business Nuclear medicine 030217 neurology & neurosurgery Magnetic Resonance Angiography Cerebral angiography |
| Zdroj: | World neurosurgery. 103 |
| ISSN: | 1878-8769 |
| Popis: | Linear accelerator stereotactic radiosurgery is one of the modalities available for the treatment of central nervous system arteriovenous malformations (AVMs). The aim of this study was to describe our 15-year experience with this technique in a single tertiary center and the analysis of outcome-related factors.From 1998 to 2013, 195 patients were treated with linear accelerator-based radiosurgery; we conducted a retrospective study collecting patient- and AVM-related variables. Treatment outcomes were obliteration, posttreatment hemorrhage, symptomatic radiation-induced changes, and 3-year neurologic status. We also analyzed prognostic factors of each outcome and predictability analysis of 5 scales: Spetzler-Martin grade, Lawton-Young supplementary and Lawton combined scores, radiosurgery-based AVM score, Virginia Radiosurgery AVM Scale, and Heidelberg score.Overall obliteration rate was 81%. Nidus diameter and venous drainage were predictive of obliteration (P0.05), ruptured status and previous embolization were not related to rate of obliteration, and low-grade AVMs had higher obliteration rates. Posttreatment hemorrhage incidence was 8.72%; nidus diameter was the only predictor (P = 0.05). Symptomatic radiation-induced changes occurred in 11.79% of patients and were significantly associated with unruptured status (P0.05). Treatment success as a composite measure was obtained in 70.77% of patients. Receiver operating characteristic curves were presented for each scoring system and outcome measure; best area under the curve was 0.687 for Lawton combined score in the obliteration outcome.In the long-term, linear accelerator-based radiosurgery is a useful, valid, effective, and safe modality for treatment of brain AVMs. |
| Databáze: | OpenAIRE |
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