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A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery
J C Flickinger1, D Kondziolka, L D Lunsford
1University of Pittsburgh, PA, USA.
Purpose:
To better understand radiation complications of arteriovenous malformation (AVM) radiosurgery and factors affecting their resolution.
Methods And Materials:
AVM patients (102/1255) who developed neurological sequelae after radiosurgery were studied. The median AVM marginal dose (Dmin) was 19 Gy (range: 10-35). The median volume was 5.7 cc (range: 0.26-143). Median follow-up was 34 months (range: 9-140).
Results:
Complications consisted of 80/102 patients with evidence of radiation injury to the brain parenchyma (7 also with cranial nerve deficits, 12 also with seizures, 5 with cyst formation), 12/102 patients with isolated cranial neuropathies, and 10/102 patients with only new or worsened seizures. Severity was classified as minimal in 39 patients, mild in 40, disabling in 21, and fatal in 2 patients. Symptoms resolved completely in 42 patients for an actuarial resolution rate of 54% +/- 7% at 3 years post-onset. Multivariate analysis identified significantly greater symptom resolution in patients with no prior history of hemorrhage (p = 0.01, 66% vs. 41%), and in patients with symptoms of minimal severity: headache or seizure as the only sequelae of radiosurgery (p < 0.0001, 88% vs. 34%).
Conclusion:
Late sequelae of radiosurgery manifest in varied ways. Further long-term studies of these problems are needed that take into account symptom severity and prior hemorrhage history.
Insights
Radiation complications after arteriovenous malformation (AVM) radiosurgery can resolve, especially for patients without prior hemorrhage and with less severe symptoms. Factors like symptom severity and hemorrhage history influence AVM radiosurgery outcomes.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Neurology
Background:
- Arteriovenous malformations (AVMs) are complex vascular lesions.
- Radiosurgery is a treatment option for AVMs.
- Understanding post-treatment complications is crucial for patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of neurological complications following AVM radiosurgery.
- To identify factors influencing the resolution of these radiation-induced complications.
Main Methods:
- Retrospective study of 102 patients who developed neurological sequelae after AVM radiosurgery.
- Analysis of patient data including AVM dose, volume, follow-up duration, symptom severity, and prior hemorrhage history.
- Multivariate analysis to determine factors associated with symptom resolution.
Main Results:
- Complications included radiation injury, cranial neuropathies, and seizures.
- Symptom severity ranged from minimal to fatal, with 54% overall resolution at 3 years.
- Resolution was significantly better in patients without prior hemorrhage (66% vs. 41%) and with minimal symptom severity (88% vs. 34%).
Conclusions:
- Late neurological sequelae after AVM radiosurgery present diversely.
- Symptom severity and a history of hemorrhage are key factors affecting complication resolution.
- Further long-term studies are warranted to refine understanding and management strategies.
