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Repeat linear accelerator radiosurgery for cerebral arteriovenous malformations
Michel Schlienger1, François Nataf, Dimitri Lefkopoulos
1Department of Radiotherapy, Radiophysics Tenon Hospital, Paris, France. michel.schlienger@tnn.ap-hop-paris.fr
Summary
Repeat radiosurgery (RS2) for cerebral arteriovenous malformations (AVMs) achieved a 59.3% obliteration rate in patients with prior failed radiosurgery (RS1). This salvage treatment offers encouraging results, with a 97% survival rate, but requires careful multidisciplinary consideration.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Vascular Neurology
Background:
- Cerebral arteriovenous malformations (AVMs) pose significant risks, including hemorrhage and neurological deficits.
- Initial radiosurgery (RS1) is a primary treatment, but failure necessitates salvage strategies.
- Repeat radiosurgery (RS2) is an option for AVMs that do not achieve obliteration after RS1.
Purpose of the Study:
- To evaluate the efficacy and safety of repeat radiosurgery (RS2) for cerebral arteriovenous malformations (AVMs) following failed initial radiosurgery (RS1).
Main Methods:
- Retrospective analysis of 41 patients undergoing RS2 between 1986 and 2000, with 32 assessable.
- Patients had Spetzler-Martin Grade 1-5 AVMs, with prior treatments including embolization and neurosurgery.
- Radiosurgery techniques (15-MV X-ray minibeams, coronal arcs) were generally consistent between RS1 and RS2.
Main Results:
- An obliteration rate of 59.3% (19 of 32 patients) was observed after RS2, with a median time to obliteration of 21 months.
- The overall survival rate was 97% (31 of 32 patients).
- Neurologic complications occurred in 9% of patients, with 3 instances of bleeding and 2 new partially regressive deficits.
Conclusions:
- Repeat radiosurgery (RS2) demonstrates encouraging outcomes for previously treated cerebral AVMs.
- A multidisciplinary approach is crucial for optimizing treatment selection and timing to minimize initial failure rates.
- RS2 should be considered when nidus reduction is less than 25% after RS1, based on annual angiograms.