Patient outcomes after stereotactic radiosurgery for "operable" arteriovenous malformations
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B E Pollock1, L D Lunsford, D Kondziolka
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Abstract:
To define the outcomes after stereotactic radiosurgery performed for smaller volume arteriovenous malformations (AVMs) that are potentially suitable for surgical removal, we retrospectively reviewed our 4-year experience in 65 patients who declined microsurgery. All 65 patients had Spetzler-Martin Grade I or II AVMs and a minimum follow-up of 24 months (median, 29 mo). Symptomatic improvement after radiosurgery occurred in 52% of patients with seizures and in 63% of patients with headaches. The annual risk of AVM hemorrhage during the latency interval after radiosurgery was 3.7%. Five patients (7.7%) had a subsequent hemorrhage (all within 8 mo of radiosurgery); two died, and three recovered (one after hematoma evacuation and two with conservative management). Forty-seven patients (72%) returned to their previous employment status or activity level within 1 week of radiosurgery (92% within 1 yr). No patient suffered radiation-related complications. Twenty-seven (84%) of 32 patients evaluated by postradiosurgical angiography had complete AVM obliteration. Radiosurgery is an effective and less invasive management strategy for Grade I or II AVM patients who are either medically unsuitable for or unwilling to undergo surgical removal. The risk of AVM hemorrhage during the latency interval until obliteration occurs appears to be no different than the natural history of untreated AVMs. These results (including hemorrhage prevention and symptom amelioration) indicate that the conservative management of small AVMs can rarely be justified.
Insights
Stereotactic radiosurgery effectively treats small arteriovenous malformations (AVMs) in patients refusing surgery. This less invasive approach offers symptom relief and AVM obliteration with acceptable hemorrhage risk.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Vascular Neurology
Background:
- Arteriovenous malformations (AVMs) pose risks of hemorrhage and neurological deficits.
- Surgical removal is a primary treatment for smaller AVMs, but some patients decline or are unsuitable for microsurgery.
Purpose of the Study:
- To evaluate outcomes of stereotactic radiosurgery (SRS) for Spetzler-Martin Grade I or II AVMs in patients who opted against microsurgery.
- To assess the efficacy, safety, and complication rates of SRS in this patient cohort.
Main Methods:
- Retrospective review of 65 patients with Grade I or II AVMs treated with SRS.
- Minimum follow-up of 24 months, with assessment of symptomatic improvement, hemorrhage risk, AVM obliteration, and functional recovery.
Main Results:
- Symptomatic improvement observed in 52% of patients with seizures and 63% with headaches.
- Annual hemorrhage risk was 3.7%, with 7.7% experiencing hemorrhage within 8 months post-SRS.
- 84% of evaluated patients achieved complete AVM obliteration; no radiation complications occurred.
Conclusions:
- SRS is an effective, less invasive alternative for patients with Grade I-II AVMs unsuitable for or declining surgery.
- The hemorrhage risk during SRS latency is comparable to natural AVM history.
- SRS offers significant benefits, rarely justifying conservative management for small AVMs.