Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain
| Autor: | Vera Parkhutik, Esperanza Mainar, Victor Vazquez, Lourdes Guillen, Jose Ignacio Tembl, Aida Lago, Fernando Aparici, Juan Francisco Vázquez |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male medicine.medical_specialty Necrosis Neurology Adolescent medicine.medical_treatment Brain Edema Radiosurgery Young Adult Edema Medicine Humans Radiology Nuclear Medicine and imaging Clinical significance Child Radiation Injuries Neuroradiology business.industry Hazard ratio Magnetic Resonance Imaging Surgery Treatment Outcome Female Neurology (clinical) Radiology Neurosurgery medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Neuroradiology. 55(4) |
| ISSN: | 1432-1920 |
| Popis: | Post-radiation injury of patients with brain arteriovenous malformations (AVM) include blood–brain barrier breakdown (BBBB), edema, and necrosis. Prevalence, clinical relevance, and response to treatment are poorly known. We present a series of consecutive brain AVM treated with stereotactic radiosurgery describing the appearance of radiation injury and clinical complications. Consecutive patients with annual clinical and radiological follow-up (median length 63 months). Edema and BBBB were classified in four groups (minimal, perilesional, moderate, or severe), and noted together with necrosis. Clinical symptoms of interest were intracranial hypertension, new neurological deficits, new seizures, and brain hemorrhages. One hundred two cases, median age 34 years, 52 % male. Median irradiated volume 3.8 cc, dose to the margin of the nidus 18.5 Gy. Nineteen patients underwent a second radiosurgery. Only 42.2 % patients remained free from radiation injury. Edema was found in 43.1 %, blood–brain barrier breakdown in 20.6 %, necrosis in 6.9 %. Major injury (moderate or severe edema, moderate or severe BBBB, or necrosis) was found in 20 of 102 patients (19.6 %). AVM diameter >3 cm and second radiosurgery were independent predictors. Time to the worst imaging was 60 months. Patients with major radiation injury had a hazard ratio for appearance of focal deficits of 7.042 (p = 0.04), of intracranial hypertension 2.857 (p = 0.025), hemorrhage into occluded nidus 9.009 (p = 0.079), appearance of new seizures not significant. Major radiation injury is frequent and increases the risk of neurological complications. Its late appearance implies that current follow-up protocols need to be extended in time. |
| Databáze: | OpenAIRE |
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