Document Detail


Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery.
MedLine Citation:
PMID:  12535357     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was undertaken to determine which factors were statistically predictive of radiological and clinical outcomes in the radiosurgical treatment of arteriovenous malformations (AVMs). METHODS: The computerized dosimetric and clinical data for 269 patients were reviewed. The AVM nidus was hand-contoured on successive enhanced computed tomographic slices through the nidus, to allow detailed determinations of nidus volume, target miss, normal brain tissue treated, dose conformality, and dose gradient. In addition, a number of patient and treatment factors, including Spetzler-Martin grade, presenting symptoms, dose, number of isocenters, radiological outcome, and clinical outcome, were subjected to multivariate analysis. RESULTS: Two hundred twenty-five patients were treated with radiosurgery for the first time, and 44 patients underwent radiosurgical retreatment. One hundred forty-three patients had AVMs located in or near "eloquent" brain areas and 126 patients did not. Seventy patients demonstrated preoperative neurological findings related to the AVM and 199 did not. Twenty-six patients had previously undergone endovascular treatment and 10 patients had previously undergone surgical treatment of their AVMs. Of the 269 patients studied, 228 experienced no complication, 10 (3.7%) experienced a transient radiation-induced complication, 3 (1%) experienced a permanent radiation-induced complication, and 28 (10%) experienced posttreatment hemorrhage. CONCLUSION: None of the analyzed factors was predictive of hemorrhage after radiosurgery in this study. The 12-Gy volume was predictive of permanent radiation-induced complications. Eloquent AVM location and 12-Gy volume were correlated with the occurrence of transient radiation-induced complications. Better conformality was correlated with a reduced incidence of transient complications. Lower Spetzler-Martin grades, higher doses, and steeper dose gradients were correlated with radiological success.
Authors:
William A Friedman; Frank J Bova; Sirisha Bollampally; Patrick Bradshaw
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  52     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-01-21     Completed Date:  2003-03-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  296-307; discussion 307-8     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA. friedman@neurosurgery.ufl.edu
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MeSH Terms
Descriptor/Qualifier:
Brain Damage, Chronic / diagnosis,  etiology
Cerebral Angiography
Cerebral Hemorrhage / diagnosis,  etiology
Humans
Intracranial Arteriovenous Malformations / diagnosis,  surgery*
Magnetic Resonance Imaging
Multivariate Analysis
Neurologic Examination / statistics & numerical data
Outcome Assessment (Health Care) / statistics & numerical data
Postoperative Complications / diagnosis,  etiology*
Prognosis
Radiosurgery*
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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