Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study, Research Support, N.I.H., Extramural
Grant support
U54 GM104942
NIGMS NIH HHS - United States
PubMed
30611144
PubMed Central
PMC6609496
DOI
10.3171/2018.8.jns181467
Knihovny.cz E-resources
- Keywords
- C-dAVF = cavernous dAVF, CVD = cortical venous drainage, GKRS = Gamma Knife radiosurgery, Gamma Knife, ICH = intracerebral hemorrhage, RIC = radiation-induced complication, SAH = subarachnoid hemorrhage, arteriovenous, dAVF = dural arteriovenous fistula, dural, fistula, outcome, stereotactic radiosurgery, vascular disorders,
- MeSH
- Central Nervous System Vascular Malformations complications diagnostic imaging surgery MeSH
- Brain Damage, Chronic epidemiology etiology prevention & control MeSH
- Adult MeSH
- Kaplan-Meier Estimate MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Neuroimaging MeSH
- Postoperative Complications epidemiology etiology prevention & control MeSH
- Postoperative Hemorrhage epidemiology etiology MeSH
- Radiation Injuries epidemiology etiology MeSH
- Radiosurgery methods MeSH
- Risk Factors MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, N.I.H., Extramural MeSH
OBJECTIVE: In this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome. METHODS: Data from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications. Patient and dAVF characteristics were assessed to determine predictors of outcome in a multivariate logistic regression analysis; dAVF-free obliteration was calculated in a competing-risk survival analysis; and Youden indices were used to determine optimal radiosurgical dose. RESULTS: A mean margin dose of 21.8 Gy was delivered. The mean follow-up duration was 4 years (range 0.5-18 years). The overall obliteration rate was 68.4%. The postradiosurgery actuarial rates of obliteration at 3, 5, 7, and 10 years were 41.3%, 61.1%, 70.1%, and 82.0%, respectively. Post-GRKS hemorrhage occurred in 4 patients (annual risk of 0.9%). Radiation-induced imaging changes occurred in 10.4% of patients; 5.2% were symptomatic, and 3.5% had permanent deficits. Favorable outcome was achieved in 63.2% of patients. Patients with middle fossa and tentorial dAVFs (OR 2.4, p = 0.048) and those receiving a margin dose greater than 23 Gy (OR 2.6, p = 0.030) were less likely to achieve a favorable outcome. Commonly used grading scales (e.g., Borden and Cognard) were not predictive of outcome. Female sex (OR 1.7, p = 0.03), absent venous ectasia (OR 3.4, p < 0.001), and cavernous carotid location (OR 2.1, p = 0.019) were predictors of GKRS-induced dAVF obliteration. CONCLUSIONS: GKRS for cerebral dAVFs achieved obliteration and avoided permanent complications in the majority of patients. Those with cavernous carotid location and no venous ectasia were more likely to have fistula obliteration following radiosurgery. Commonly used grading scales were not reliable predictors of outcome following radiosurgery.
Department of Neurological Surgery Na Homolce Hospital Prague Czech Republic; and
Department of Neurological Surgery University of Manitoba Winnipeg Canada
Department of Neurological Surgery University of Miami Florida
Department of Neurological Surgery University of Pennsylvania Philadelphia Pennsylvania
Department of Neurological Surgery University of Pittsburgh
Department of Neurological Surgery University of Puerto Rico San Juan Puerto Rico
Department of Neurological Surgery University of Sherbrooke Quebec
Department of Neurological Surgery University of Virginia Charlottesville Virginia
Department of Radiation Oncology Beaumont Health System Royal Oak Michigan
Departments of8Neurological Surgery and
Radiation Oncology West Virginia University Morgantown West Virginia
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