Does Variceal Drainage Affect Arteriovenous Malformation Obliteration and Hemorrhage Rates After Stereotactic Radiosurgery? A Case-Matched Analysis
| Autor: | Nima Alan, Alp Ozpinar, L. Dade Lunsford, Ajay Niranjan, John C. Flickinger, Andrew Faramand, Nitin Agarwal, Hideuyki Kano |
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| Rok vydání: | 2020 |
| Předmět: |
Intracranial Arteriovenous Malformations
medicine.medical_specialty medicine.medical_treatment Hemorrhage 030204 cardiovascular system & hematology Radiosurgery 03 medical and health sciences 0302 clinical medicine Medicine Humans In patient Drainage Retrospective Studies Varix business.industry Venous drainage Arteriovenous malformation medicine.disease CONGENITAL ARTERIOVENOUS MALFORMATION Treatment Outcome Surgery Neurology (clinical) Radiology Varices business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Neurosurgery. 89(4) |
| ISSN: | 1524-4040 |
| Popis: | Background Stereotactic radiosurgery (SRS) is widely accepted as a minimally invasive alternative to surgery in the management of arteriovenous malformations (AVMs). Dilated AVM outflow veins or varices may be caused by high-flow or partial outflow obstruction, which may increase the risk of a hemorrhage before or after SRS. Objective To compare the obliteration and hemorrhage risks in patients with and without AVM varices (AVMv). Methods From our prospective database of 1012 AVM patients who underwent Gamma Knife® (Elekta) SRS, we identified 103 patients with AVMv, and 847 patients without varices. The median follow-up was 52 mo. Balancing variable score matching was performed to compare obliteration and hemorrhage rates between the 2 groups. Results Obliteration rates in the AVMv group were 38% at 3 yr, 65% at 4 yr, and 70% at 5 yr. Patients with an AVMv had no difference in the final obliteration rate compared to patients who did not have variceal drainage (P = .35). Actuarial hemorrhage after SRS in the matched patients with AVMv was 4.9%, 13%, and 13.7%, at 1, 3, and 5 yr, respectively. The rate of hemorrhage in the group with no varix was 2.9%, 5.4%, and 9.1% at 1, 3, and 5 yr, respectively (P = .14). Conclusion The presence of AVM variceal venous drainage did not affect the obliteration rate and did not confer a higher risk of a subsequent hemorrhage both before and after SRS. |
| Databáze: | OpenAIRE |
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