Stereotactic radiosurgery for arteriovenous malformations after Onyx embolization: a case-control study
| Autor: | Ching-Jen Chen, Chun-Po Yen, Zhiyuan Xu, Benjamin Z Ball, Jason P. Sheehan, Cheng-Chia Lee, David Schlesinger |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male medicine.medical_specialty Adolescent medicine.medical_treatment Propensity score method Kaplan-Meier Estimate Tantalum Radiosurgery Young Adult medicine Humans Dimethyl Sulfoxide Embolization Risks and benefits Child Aged Aged 80 and over business.industry Case-control study Onyx embolization Arteriovenous malformation Middle Aged medicine.disease Combined Modality Therapy Embolization Therapeutic Magnetic Resonance Imaging Drug Combinations Logistic Models Treatment Outcome Case-Control Studies Female Polyvinyls Radiology business |
| Zdroj: | Journal of neurosurgery. 123(1) |
| ISSN: | 1933-0693 |
| Popis: | OBJECT Onyx, an ethylene-vinyl alcohol copolymer mixed in a dimethyl sulfoxide solvent, is currently one of the most widely used liquid materials for embolization of intracranial arteriovenous malformations (AVMs). The goal of this study was to define the risks and benefits of stereotactic radiosurgery (SRS) for patients who have previously undergone partial AVM embolization with Onyx. METHODS Among a consecutive series of 199 patients who underwent SRS between January 2007 and December 2012 at the University of Virginia, 25 patients had Onyx embolization prior to SRS (the embolization group). To analyze the obliteration rates and complications, 50 patients who underwent SRS without prior embolization (the no-embolization group) were matched by propensity score method. The matched variables included age, sex, nidus volume before SRS, margin dose, Spetzler-Martin grade, Virginia Radiosurgery AVM Scale score, and median imaging follow-up period. RESULTS After Onyx embolization, 18 AVMs were reduced in size. Total obliteration was achieved in 6 cases (24%) at a median of 27.5 months after SRS. In the no-embolization group, total obliteration was achieved in 20 patients (40%) at a median of 22.4 months after SRS. Kaplan-Meier analysis demonstrated obliteration rates of 17.7% and 34.1% in the embolization group at 2 and 4 years, respectively. In the no-embolization group, the corresponding obliteration rates were 27.0% and 55.9%. The between-groups difference in obliteration rates after SRS did not achieve statistical significance. The difference in complications, including adverse radiation effects, hemorrhage episodes, seizure control, and patient mortality also did not reach statistical significance. CONCLUSIONS Onyx embolization can effectively reduce the size of many AVMs. This case-control study did not show any statistically significant difference in the rates of embolization or complications after SRS in patients who had previously undergone Onyx embolization and those who had not. |
| Databáze: | OpenAIRE |
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