Repeat radiosurgery for cerebral arteriovenous malformations.
We perform a systematic review of repeat radiosurgery for cerebral arteriovenous malformations (AVM) with an emphasis on lesion obliteration rates and complications. Radiosurgery is an accepted treatment modality for AVM located in eloquent cortex or deep brain structures. For residual or persistent lesions, repeat radiosurgery can be considered if sufficient time has passed to allow for a full appreciation of treatment effects, usually at least 3years. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. References for this review were identified by searches of MEDLINE, Web of Science and Google Scholar databases. A total of 14 studies comprising 733 patients met the review criteria and were included. For series that reported target dose at both first and repeat treatments, the weighted means were 19.42Gy and 19.06Gy, respectively. The mean and median obliteration rate for the repeat radiosurgery treatments were 61% (95% confidence interval 51.9-71.7%) and 61.5%, respectively. The median follow up following radiosurgery ranged from 19.5 to 80months. Time to complete obliteration after the repeat treatment ranged from 21 to 40.8months. The most common complications of repeat radiosurgery for AVM included hemorrhage (7.6%) and radiation-induced changes (7.4%). Repeat radiosurgery can be used to treat incompletely obliterated AVM with an obliteration rate of 61%. Complications are related to treatment effect latency (hemorrhage risk) as well as radiation-induced changes. Repeat radiosurgery can be performed at 3 years following the initial treatment, allowing for full realization of effects from the initial treatment prior to commencing therapy.
Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Ahmed J
AJ
Awad
Department of Neurological Surgery, Massachusetts General Hospital, White Building Room 502, 55 Fruit Street, Boston, MA 02114, USA.
Brian P
BP
Walcott
Department of Neurological Surgery, Massachusetts General Hospital, White Building Room 502, 55 Fruit Street, Boston, MA 02114, USA.
Christopher J
CJ
Stapleton
Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.
Dale
D
Ding
Department of Neurological Surgery, Massachusetts General Hospital, White Building Room 502, 55 Fruit Street, Boston, MA 02114, USA.
Cheng-Chia
CC
Leed
Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Jay S
JS
Loeffler
D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
Arteriovenous malformation; Gamma knife; LINAC; Neurosurgery; Retreatment; Stereotactic radiosurgery