Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104863. doi: 10.1016/j.jstrokecerebrovasdis.2020.104863. Epub 2020 Jun 8.
High arteriovenous malformation (AVM) obliteration rates have been reported with stereotactic radiosurgery (SRS), and multiple factors have been found to be associated with AVM obliteration. These predictors have been inconsistent throughout studies. We aimed to analyze our experience with linear accelerator (LINAC)-based SRS for brain AVMs, evaluate outcomes, assess factors associated with AVM obliteration and review the various reported predictors of AVM obliteration.
Electronic medical records were retrospectively reviewed to identify consecutive patients with brain AVMs treated with SRS over a 27-year period with at least 2 years of follow-up. Logistic regression analysis was performed to identify factors associated with AVM obliteration.
One hundred twenty-eight patients with 142 brain AVMs treated with SRS were included. Mean age was 34.4 years. Fifty-two percent of AVMs were associated with a hemorrhage before SRS, and 14.8% were previously embolized. Mean clinical and angiographic follow-up times were 67.8 months and 58.6 months, respectively. The median Spetzler-Martin grade was 3. Mean maximal AVM diameter was 2.8 cm and mean AVM target volume was 7.4 cm with a median radiation dose of 16 Gy. Complete AVM obliteration was achieved in 80.3%. Radiation-related signs and symptoms were encountered in 32.4%, only 4.9% of which consisted of a permanent deficit. Post-SRS AVM-related hemorrhage occurred in 6.3% of cases. In multivariate analysis, factors associated with AVM obliteration included younger patient age (P = .019), male gender (P = .008), smaller AVM diameter (P = .04), smaller AVM target volume (P = .009), smaller isodose surface volume (P = .005), a higher delivered radiation dose (P = .013), and having only one major draining vein (P = .04).
AVM obliteration with LINAC-based radiosurgery was safe and effective and achieved complete AVM obliteration in about 80% of cases. The most prominent predictors of AVM success included AVM size, AVM volume, radiation dose, number of draining veins and patient age.
立体定向放射外科（SRS）可实现高动静脉畸形（AVM）闭塞率，且已有多项研究发现多种因素与 AVM 闭塞相关。这些预测因子在不同研究中并不一致。我们旨在分析我们应用线性加速器（LINAC）SRS 治疗脑 AVM 的经验，评估结果，评估与 AVM 闭塞相关的因素，并回顾各种报道的 AVM 闭塞预测因子。
回顾性分析 27 年来至少接受 2 年随访的接受 SRS 治疗的脑 AVM 连续患者的电子病历。采用逻辑回归分析识别与 AVM 闭塞相关的因素。
共纳入 128 例 142 个脑 AVM 患者接受 SRS 治疗。平均年龄为 34.4 岁。52%的 AVM 在 SRS 前有出血史，14.8%的 AVM 曾行栓塞术。临床和血管造影随访中位时间分别为 67.8 个月和 58.6 个月。Spetzler-Martin 分级中位数为 3 级。最大 AVM 直径的平均值为 2.8cm，AVM 靶体积的平均值为 7.4cm，中位放射剂量为 16Gy。80.3%的患者完全闭塞 AVM。32.4%的患者出现放射相关症状和体征，仅有 4.9%的患者出现永久性缺陷。SRS 后 AVM 相关性出血发生率为 6.3%。多因素分析显示，与 AVM 闭塞相关的因素包括患者年龄较小（P=0.019）、男性（P=0.008）、AVM 直径较小（P=0.04）、AVM 靶体积较小（P=0.009）、等剂量表面体积较小（P=0.005）、较高的放射剂量（P=0.013）和仅有一条主要引流静脉（P=0.04）。
应用 LINAC 放射外科治疗 AVM 安全有效，约 80%的患者可实现完全闭塞。AVM 成功的最显著预测因子包括 AVM 大小、AVM 体积、放射剂量、引流静脉数量和患者年龄。
