title: Assessment of neuropsychological changes in patients with arteriovenous malformation (AVM) after radiosurgery.
abstract: OBJECTIVE
  The purpose of this study was to investigate neuropsychological effects of radiosurgery in patients with cerebral arteriovenous malformation (AVM), with special focus on attention and memory. This report describes the study setup and presents the first results during a follow-up of up to 1 year.
  
  
  METHODS
  Seventy-nine patients were studied before, acutely after radiosurgery, and during the regular follow-up (subacute phase: Weeks 6-12, chronic phase: Months 6-12). Radiosurgery was performed using a modified linear accelerator (minimum doses to the target volume: 15-22 Gy, median 20 Gy). Estimated whole brain dose was 0.5 to 2 Gy. Neuropsychological testing included assessment of general intelligence (Wechsler Adult Intelligence Scale), attention (modified Trail-Making Test A, Digit Symbol Test, D2 Test, Wiener Determination Machine) and memory (Rey Auditory Verbal Learning Test, Benton Visual Retention Test). During follow-up, alternate test versions were used. Neuropsychological deficits were defined as a test score of at least one standard deviation (SD) below the mean of the normal distribution.
  
  
  RESULTS
  The pretherapeutic evaluation revealed marked deviations from the normal population; 24% had deficits in intelligence (range 23-31% in different subtests), attention (35%, 23-59%) and memory (48%, 31-61%). The overall percentage of aberrant results was reduced by 12% (memory) to 14% (attention) in the chronic phase up to 12 months after therapy. The improvement in test scores was significant (p < 0.05) in 3 of 4 subtests of attention functions.
  
  
  CONCLUSIONS
  The acute tolerance of radiosurgery seems to be very good in these patients, showing no relevant increase in number of patients with neuropsychological deficits. Although the long-term follow-up needs to be further increased, our data indicate a tendency to slight improvement in the overall neuropsychological performance of AVM patients in the chronic phase after radiosurgery.
authors.affiliation: Department of Clinical Radiology, University of Heidelberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Wenz
authors.forename: S
authors.initials: S
authors.lastname: Steinvorth
authors.forename: S
authors.initials: S
authors.lastname: Wildermuth
authors.forename: F
authors.initials: F
authors.lastname: Lohr
authors.forename: M
authors.initials: M
authors.lastname: Fuss
authors.forename: J
authors.initials: J
authors.lastname: Debus
authors.forename: M
authors.initials: M
authors.lastname: Essig
authors.forename: W
authors.initials: W
authors.lastname: Hacke
authors.forename: M
authors.initials: M
authors.lastname: Wannenmacher
mesh_terms: D000328:Adult; D001288:Attention / Q000528:radiation effects; D005260:Female; D006801:Humans; D007360:Intelligence / Q000528:radiation effects; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008568:Memory / Q000528:radiation effects; D009483:Neuropsychological Tests; D011446:Prospective Studies; D016634:Radiosurgery