Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
Neurosurgery. 2018 Sep 1;83(3):365-376. doi: 10.1093/neuros/nyx502.
Radiation-induced changes (RICs) are the most common complication of stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs), and they appear as perinidal T2-weighted hyperintensities on magnetic resonance imaging, with or without associated neurological symptoms.
To determine the rates of RIC after AVM SRS and identify risk factors.
A literature review was performed using PubMed and MEDLINE to identify studies reporting RIC in AVM patients treated with SRS. RICs were classified as radiologic (any neuroimaging evidence), symptomatic (any associated neurological deterioration, regardless of duration), and permanent (neurological decline without recovery). Baseline, treatment, and outcomes data were extracted for statistical analysis.
Based on pooled data from 51 studies, the overall rates of radiologic, symptomatic, and permanent RIC after AVM SRS were 35.5% (1143/3222 patients, 32 studies), 9.2% (499/5447 patients, 46 studies), and 3.8% (202/5272 patients, 39 studies), respectively. Radiologic RIC was significantly associated with lack of prior AVM rupture (odds ratio [OR] = 0.57; 95% confidence interval [CI]: 0.47-0.69; P < .001) and treatment with repeat SRS (OR = 6.19; 95% CI: 2.42-15.85; P < .001). Symptomatic RIC was significantly associated with deep AVM location (OR = 0.38; 95% CI: 0.21-0.67; P < .001).
Approximately 1 in 3 patients with AVMs treated with SRS develop radiologically evident RIC, and of those with radiologic RIC, 1 in 4 develop neurological symptoms. Lack of prior AVM hemorrhage and repeat SRS are risk factors for radiologic RIC, and deep nidus location is a risk factor for symptomatic RIC.
放射性改变（RICs）是立体定向放射外科（SRS）治疗脑动静脉畸形（AVMs）最常见的并发症，其在磁共振成像上表现为瘤周 T2 加权高信号，伴有或不伴有相关的神经症状。
确定 AVM SRS 后 RIC 的发生率，并确定其危险因素。
使用 PubMed 和 MEDLINE 进行文献回顾，以确定报道 SRS 治疗 AVM 患者发生 RIC 的研究。RICs 分为影像学（任何神经影像学证据）、症状性（任何相关的神经功能恶化，无论持续时间如何）和永久性（神经功能下降无恢复）。提取基线、治疗和结局数据进行统计学分析。
基于 51 项研究的汇总数据，AVM SRS 后影像学、症状性和永久性 RIC 的总体发生率分别为 35.5%（3222 例患者中有 1143 例，32 项研究）、9.2%（499/5447 例患者，46 项研究）和 3.8%（5272 例患者中有 202 例，39 项研究）。影像学 RIC 与既往 AVM 破裂缺失（比值比 [OR] = 0.57；95%置信区间 [CI]：0.47-0.69；P < 0.001）和重复 SRS 治疗（OR = 6.19；95% CI：2.42-15.85；P < 0.001）显著相关。症状性 RIC 与深部 AVM 位置显著相关（OR = 0.38；95% CI：0.21-0.67；P < 0.001）。
大约每 3 例接受 SRS 治疗的 AVM 患者中就有 1 例出现影像学上明显的 RIC，而在有影像学 RIC 的患者中，有 1 例出现神经症状。既往 AVM 出血缺失和重复 SRS 是影像学 RIC 的危险因素，深部瘤巢位置是症状性 RIC 的危险因素。
