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Bleeding after radiosurgery for cerebral arteriovenous malformations
François Nataf1, May Ghossoub, Michel Schlienger
1Department of Neurosurgery, Centre Hospitalier Sainte-Anne, Paris, France. nataf@chsa.broca.inserm.fr
Neurosurgery
|July 24, 2004
Summary
Hemorrhage risk after radiosurgery (RS) for cerebral arteriovenous malformation (AVM) is linked to AVM-specific factors and incomplete obliteration. Identifying these factors can help predict, but rarely avoid, post-RS bleeding events.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Radiology
Background:
- Cerebral arteriovenous malformations (AVMs) pose a significant hemorrhage risk.
- Radiosurgery (RS) is a treatment for AVMs, but obliteration is progressive.
- Hemorrhage risk persists until AVM obliteration is complete.
Purpose of the Study:
- To evaluate hemorrhage severity and actuarial risk after RS for AVM.
- To identify clinical, anatomic, and dosimetric parameters associated with post-RS hemorrhage.
- To analyze factors influencing hemorrhage risk and obliteration rates.
Main Methods:
- Retrospective study of 756 patients treated with linear accelerator RS for AVM.
- Analysis of 51 patients experiencing hemorrhage post-RS.
- Univariate and multivariate analyses (Kaplan-Meier, Cox model) of hemorrhage risk factors.
Main Results:
- Parenchymal hemorrhages caused significant morbidity (47.6% overall, 26.2% permanent deficit).
- Mean obliteration rate before hemorrhage was 24%; actuarial hemorrhage rates were 3.08%/year/patient.
- Hemorrhage risk correlated with intranidal/paranidal aneurysms, complete coverage, and minimum dose.
Conclusions:
- Hemorrhage risk post-RS is a combination of AVM-related factors and poor obliteration predictors.
- These predictive factors are identifiable but often unavoidable.
- Understanding these factors is crucial for managing AVM treatment outcomes.