A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery.
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.
Flickinger
J C
JC
University of Pittsburgh, PA, USA.
Kondziolka
D
D
Lunsford
L D
LD
Pollock
B E
BE
Yamamoto
M
M
Gorman
D A
DA
Schomberg
P J
PJ
Sneed
P
P
Larson
D
D
Smith
V
V
McDermott
M W
MW
Miyawaki
L
L
Chilton
J
J
Morantz
R A
RA
Young
B
B
Jokura
H
H
Liscak
R
R
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
D000305:Adrenal Cortex Hormones