Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Feasibility of Gamma Knife Radiosurgery for Brain Arteriovenous Malformations According to Nidus Type

  • Ja Ho Koo (Department of Neurosurgery, Ajou University School of Medicine) ;
  • Eui Hyun Hwang (Department of Neurosurgery, Ajou University School of Medicine) ;
  • Ji Hye Song (Department of Neurosurgery, Ajou University School of Medicine) ;
  • Yong Cheol Lim (Department of Neurosurgery, Ajou University School of Medicine)
  • Received : 2023.08.26
  • Accepted : 2023.10.25
  • Published : 2024.07.01
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Abstract

Objective : Gamma Knife radiosurgery (GKRS) is an effective and noninvasive treatment for high-risk arteriovenous malformations (AVMs). Since differences in GKRS outcomes by nidus type are unknown, this study evaluated GKRS feasibility and safety in patients with brain AVMs. Methods : This single-center retrospective study included patients with AVM who underwent GKRS between 2008 and 2021. Patients were divided into compact- and diffuse-type groups according to nidus characteristics. We excluded patients who performed GKRS and did not follow-up evaluation with magnetic resonance imaging or digital subtraction angiography within 36 months from the study. We used univariate and multivariate analyses to characterize associations of nidus type with obliteration rate and GKRS-related complications. Results : We enrolled 154 patients (mean age, 32.14±17.17 years; mean post-GKRS follow-up, 52.10±33.67 months) of whom 131 (85.1%) had compact- and 23 (14.9%) diffuse-type nidus AVMs. Of all AVMs, 89 (57.8%) were unruptured, and 65 (42.2%) had ruptured. The mean Spetzler-Martin AVM grades were 2.03±0.95 and 3.39±1.23 for the compact- and diffuse-type groups, respectively (p<0.001). During the follow-up period, AVM-related hemorrhages occurred in four individuals (2.6%), three of whom had compact nidi. Substantial radiation-induced changes and cyst formation were observed in 21 (13.6%) and one patient (0.6%), respectively. The AVM complete obliteration rate was 46.1% across both groups. Post-GKRS complication and complete obliteration rates were not significantly different between nidus types. For diffuse-type nidus AVMs, larger AVM size and volume (p<0.001), lower radiation dose (p<0.001), eloquent area location (p=0.015), and higher Spetzler-Martin grade (p<0.001) were observed. Conclusion : GKRS is a safe and feasible treatment for brain AVMs characterized by both diffuse- and compact-type nidi.

Keywords

References

  1. Chang JH, Chang JW, Park YG, Chung SS : Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 93 Suppl 3 : 96-101, 2000
  2. China M, Vastani A, Hill CS, Tancu C, Grover PJ : Gamma knife radiosurgery for cerebral arteriovenous malformations: a systematic review and meta-analysis. Neurosurg Rev 45 : 1987-2004, 2022
  3. Cohen-Inbar O, Ding D, Chen CJ, Sheehan JP : Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 1: brainstem arteriovenous malformations. J Clin Neurosci 24 : 30-36, 2016
  4. Ding D, Xu Z, Shih HH, Starke RM, Yen CP, Sheehan JP : Stereotactic radiosurgery for partially resected cerebral arteriovenous malformations. World Neurosurg 85 : 263-272, 2016
  5. Ding D, Yen CP, Xu Z, Starke RM, Sheehan JP : Radiosurgery for primary motor and sensory cortex arteriovenous malformations: outcomes and the effect of eloquent location. Neurosurgery 73 : 816-824; discussion 824, 2013
  6. Du R, Keyoung HM, Dowd CF, Young WL, Lawton MT : The effects of diffuseness and deep perforating artery supply on outcomes after microsurgical resection of brain arteriovenous malformations. Neurosurgery 60 : 638-646; discussion 646-648, 2007
  7. Flickinger JC, Kondziolka D, Pollock BE, Maitz AH, Lunsford LD : Complications from arteriovenous malformation radiosurgery: multivariate analysis and risk modeling. Int J Radiat Oncol Biol Phys 38 : 485-490, 1997
  8. Ganz JC, Reda WA, Abdelkarim K : Adverse radiation effects after gamma knife surgery in relation to dose and volume. Acta Neurochir (Wien) 151 : 9-19, 2009
  9. Graffeo CS, Sahgal A, De Salles A, Fariselli L, Levivier M, Ma L, et al. : Stereotactic radiosurgery for Spetzler-Martin grade I and II arteriovenous malformations: International Society of Stereotactic Radiosurgery (ISRS) practice guideline. Neurosurgery 87 : 442-452, 2020
  10. Gross BA, Du R : Natural history of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg 118 : 437-443, 2013
  11. Ivanov AA, Alaraj A, Charbel FT, Aletich V, Amin-Hanjani S : Recurrence of cerebral arteriovenous malformations following resection in adults: does preoperative embolization increase the risk? Neurosurgery 78 : 562-571, 2016
  12. Kano H, Flickinger JC, Tonetti D, Hsu A, Yang HC, Flannery TJ, et al. : Estimating the risks of adverse radiation effects after gamma knife radiosurgery for arteriovenous malformations. Stroke 48.1: 84-90, 2017
  13. Kano H, Kondziolka D, Flickinger JC, Park KJ, Parry PV, Yang H, et al. : Multistaged volumetric management of large arteriovenous malformations in Niranjan A, Kano H, Lunsford LD (eds) : Gamma Knife Radiosurgery for Brain Vascular Malformations. Basel : Karger Publishers, 2013, Vol 27, pp73-80
  14. Klimo P Jr, Rao G, Brockmeyer D : Pediatric arteriovenous malformations: a 15-year experience with an emphasis on residual and recurrent lesions. Childs Nerv Syst 23 : 31-37, 2007
  15. Liscak R, Vladyka V, Simonova G, Urgosik D, Novotny J Jr, Janouskova L, et al. : arteriovenous malformations after leksell gamma knife radiosurgery: rate of obliteration and complications. Neurosurgery 60 : 1005-1014; discussion 1015-1016, 2007
  16. Morgan MK, Sekhon LH, Finfer S, Grinnell V : Delayed neurological deterioration following resection of arteriovenous malformations of the brain. J Neurosurg 90 : 695-701, 1999
  17. Pan JW, Zhou HJ, Zhan RY, Wan S, Yan M, Fan WJ, et al. : Supratentorial brain AVM embolization with onyx-18 and post-embolization management. a single-center experience. Interv Neuroradiol 15 : 275-282, 2009
  18. Park CK, Choi SK, Lee SH, Choi MK, Lim YJ : Clinical outcomes and radiosurgical considerations for pediatric arteriovenous malformation: influence of clinical features on obliteration rate. Childs Nerv Syst 33 : 2137-2145, 2017
  19. Pollock BE, Link MJ, Stafford SL, Garces YI, Foote RL : Stereotactic radiosurgery for arteriovenous malformations: the effect of treatment period on patient outcomes. Neurosurgery 78 : 499-509, 2016
  20. Shin M, Maruyama K, Kurita H, Kawamoto S, Tago M, Terahara A, et al. : Analysis of nidus obliteration rates after gamma knife surgery for arteriovenous malformations based on long-term follow-up data: the University of Tokyo experience. J Neurosurg 101 : 18-24, 2004
  21. Spetzler RF, Ponce FA : A 3-tier classification of cerebral arteriovenous malformations. Clinical article. J Neurosurg 114 : 842-849, 2011
  22. van Beijnum J, van der Worp HB, Buis DR, Al-Shahi Salman R, Kappelle LJ, Rinkel GJ, et al. : Treatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA 306 : 2011-2019, 2011
  23. Yang HC, Peng SJ, Lee CC, Wu HM, Chen YW, Lin CJ, et al. : Does the diffuseness of the nidus affect the outcome of stereotactic radiosurgery in patients with unruptured cerebral arteriovenous malformations? Stereotact Funct Neurosurg 99 : 113-122, 2021
  24. Zipfel GJ, Bradshaw P, Bova FJ, Friedman WA : Do the morphological characteristics of arteriovenous malformations affect the results of radiosurgery? J Neurosurg 101 : 393-401, 2004