Long-term follow up data on difficult to treat intracranial arteriovenous malformations treated with the CyberKnife. (March 2019)

• Record Type: Journal Article
• Authors: Gupta, Raghav; Moore, Justin M.; Amorin, Alvaro; Appelboom, Geoff; Chaudhary, Navjot; Iyer, Aditya; Soltys, Scott G.; Gibbs, Iris C.; Steinberg, Gary K.; Chang, Steven D.
• Is Part Of: Journal of clinical neuroscience. Volume 61(2019)
• Page Start: 120
• Page End: 123
• Publication Date: 2019-03
• Subjects: AVMs -- Follow up -- Radiosurgery -- CyberKnife -- Patient outcomes -- Multimodal treatment; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.10.109
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Intracranial AVMs are rare, congenital, vascular lesions. Long-term follow-up data on AVMs treated with the CyberKnife, is limited. In our series patients were followed for an average of 85.2 months. Two-thirds of AVMs were obliterated at last imaging follow up. Transient post-radiosurgery adverse effects were common (55.6%). Abstract: Introduction: The CyberKnife, a frameless, robotic, stereotactic device, has been developed to radiosurgically treat arteriovenous malformations (AVMs). While most AVMs are obliterated within two-to-three years, a subset remain recalcitrant; long-term data on these difficult to treat AVMs are limited in the neurosurgical literature. Materials and methods: A retrospective analysis of all patients who underwent CyberKnife treatment for intracranial AVMs at a single U.S. institution between 2002 and 2012, whose AVMs had failed to obliterate within 48 months or longer from the treatment start date, were eligible for inclusion. Results: Eleven patients (9 AVMs; 7 males, 2 females) were followed for an average of 85.2 months (range 56.2–119.4). The median lesion size was 3.5 cm (range: 2.8–8.0 cm) and median Spetzler-Martin grade was 3 (range: 2–5). All AVMs were treated with one radiation dose (median prescribed dose was 18.0 Gy; median Dmax : 23.7 Gy). Six (66.7%) were obliterated in a median time of 84 months (range: 52–94 months), while 3 (33.3%) remained active after a median of 90.8 months (range 69.7–119.4). Transient, post-radiosurgery adverse radiation effects occurred in 5 (55.6%) cases. One (11.1%) patient had an acute hemorrhage from the AVM after radiosurgery. Four (44.4%) patients underwent repeat radiosurgery and/or embolization. Three of these lesions eventually obliterated, while 1 did not. Conclusion: The median time to obliteration was 84 months. Two-thirds of AVMs which persisted for over 4 years following initial radiosurgery treatment eventually obliterated. Transient post-radiosurgery adverse effects were common; delayed hemorrhages were rare in our case series.