title: A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery.
abstract: OBJECTIVE
  To better understand radiation complications of arteriovenous malformation (AVM) radiosurgery and factors affecting their resolution.
  
  
  METHODS
  AVM patients (102/1255) who developed neurological sequelae after radiosurgery were studied. The median AVM marginal dose (Dmin) was 19 Gy (range: 10-35). The median volume was 5.7 cc (range: 0.26-143). Median follow-up was 34 months (range: 9-140).
  
  
  RESULTS
  Complications consisted of 80/102 patients with evidence of radiation injury to the brain parenchyma (7 also with cranial nerve deficits, 12 also with seizures, 5 with cyst formation), 12/102 patients with isolated cranial neuropathies, and 10/102 patients with only new or worsened seizures. Severity was classified as minimal in 39 patients, mild in 40, disabling in 21, and fatal in 2 patients. Symptoms resolved completely in 42 patients for an actuarial resolution rate of 54% +/- 7% at 3 years post-onset. Multivariate analysis identified significantly greater symptom resolution in patients with no prior history of hemorrhage (p = 0.01, 66% vs. 41%), and in patients with symptoms of minimal severity: headache or seizure as the only sequelae of radiosurgery (p < 0.0001, 88% vs. 34%).
  
  
  CONCLUSIONS
  Late sequelae of radiosurgery manifest in varied ways. Further long-term studies of these problems are needed that take into account symptom severity and prior hemorrhage history.
authors.affiliation: University of Pittsburgh, PA, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: D
authors.initials: D
authors.lastname: Kondziolka
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
authors.forename: B E
authors.initials: BE
authors.lastname: Pollock
authors.forename: M
authors.initials: M
authors.lastname: Yamamoto
authors.forename: D A
authors.initials: DA
authors.lastname: Gorman
authors.forename: P J
authors.initials: PJ
authors.lastname: Schomberg
authors.forename: P
authors.initials: P
authors.lastname: Sneed
authors.forename: D
authors.initials: D
authors.lastname: Larson
authors.forename: V
authors.initials: V
authors.lastname: Smith
authors.forename: M W
authors.initials: MW
authors.lastname: McDermott
authors.forename: L
authors.initials: L
authors.lastname: Miyawaki
authors.forename: J
authors.initials: J
authors.lastname: Chilton
authors.forename: R A
authors.initials: RA
authors.lastname: Morantz
authors.forename: B
authors.initials: B
authors.lastname: Young
authors.forename: H
authors.initials: H
authors.lastname: Jokura
authors.forename: R
authors.initials: R
authors.lastname: Liscak
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000704:Analysis of Variance; D001921:Brain / Q000187:drug effects / Q000528:radiation effects*; D001927:Brain Diseases / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000209:etiology; D003560:Cysts / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000150:complications* / Q000188:drug therapy; D016634:Radiosurgery / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones