Neuropsychological outcomes of stereotactic radiotherapy for cerebral arteriovenous malformations.
To our knowledge, this is the first study to investigate cognitive outcome in patients with large or surgically inaccessible cerebral arteriovenous malformations (AVMs), who were treated with hypo-fractionated stereotactic radiotherapy (HSRT). A sample of 10 patients with AVMs was assessed up to 3.5 years post-HSRT. All patients were treated with HSRT to a total dose of 55 Gy in 11 fractions over a treatment period of 2.5 weeks. Neuropsychological assessments were given prior to radiotherapy and then at three time points following radiotherapy: 6 weeks, 6 months and 2.5-3.5 years post-treatment. The cognitive domains of attention, processing speed, learning, memory, semantic processing, naming, verbal fluency, visuospatial and executive function were assessed. Findings revealed that prior to radiotherapy the patient group was impaired in five of the nine cognitive domains. Post-treatment performances remained stable in the majority of domains; however, there was some fluctuation in semantic processing and memory performances. At 6 weeks post-treatment, a mild decrement was found in semantic processing ability; however, restoration to baseline levels was observed from 6 months onwards. At 2.5-3.5 years post-treatment, improvement was seen in the cohort's ability to remember new information when performances were compared with earlier time points. This study demonstrated improvements in memory several years after HSRT treatment. Further, this form of treatment was not associated with long-term, harmful cognitive side effects for these 10 patients encouraging further study of this treatment method. Further evaluation of the entire cohort is required to assess efficacy in terms of AVM obliteration and other potential side effects.
Melbourne School of Psychological Sciences, Redmond Barry Building, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
Andrea L
AL
Murray
Radiation Oncology, Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.
Michael
M
Dally
Melbourne School of Psychological Sciences, Redmond Barry Building, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
Aimee
A
Jeffreys
Department of Surgery, Monash University, Melbourne, VIC, Australia; Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, Australia.
Peter
P
Hwang
Melbourne School of Psychological Sciences, Redmond Barry Building, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia; Psychology Department, Alfred Health, Melbourne, VIC, Australia. Electronic address: jfande@unimelb.edu.au.
Jacqueline F I
JF
Anderson
D000328:Adult; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D016634:Radiosurgery / Q000009:adverse effects; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
Arteriovenous malformation; Cognition; Follow-up; Radiotherapy