title: Radiosurgery for Cerebral Arteriovenous Malformations in Elderly Patients: Effect of Advanced Age on Outcomes After Intervention.
abstract: OBJECTIVE
  Cerebral arteriovenous malformations (AVM) are infrequently diagnosed and treated in elderly patients (age, >60 years). We hypothesize that, in contrast to AVM surgical outcomes, radiosurgery outcomes are not adversely affected by increased age. The goals of this case-control study are to analyze the radiosurgery outcomes for elderly patients with AVMs and determine the effect of elderly age on AVM radiosurgery outcomes.
  
  
  METHODS
  We evaluated a prospective database of patients with AVMs treated with radiosurgery from 1989 to 2013. Elderly patients with AVM (age, ≥ 60 years) with radiologic follow-up of ≥ 2 years or nidus obliteration were selected for analysis, and matched, in a 1:1 fashion and blinded to outcome, to adult nonelderly patients with AVM (age, <60 years). Statistical analyses were performed to determine actuarial obliteration rates and evaluate the relationship between elderly age and AVM radiosurgery outcomes.
  
  
  RESULTS
  The matching processes yielded 66 patients in each of the elderly and nonelderly AVM cohorts. In the elderly AVM cohort, the actuarial AVM obliteration rates at 3, 5, and 10 years were 37%, 65%, and 77%, respectively; the rates of radiologically evident, symptomatic, and permanent radiation-induced changes were 36%, 11%, and 0%, respectively; the annual hemorrhage risk after radiosurgery was 1.1%, and the AVM-related mortality rate was 1.5%. Elderly age was not significantly associated with AVM obliteration, radiation-induced changes, or hemorrhage after radiosurgery.
  
  
  CONCLUSIONS
  Advanced age does not appear to confer appreciably worse AVM radiosurgery outcomes, unlike its negative effect on AVM surgical outcomes. Thus, when an AVM warrants treatment, radiosurgery may be the preferred treatment for elderly patients.
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jps2f@virginia.edu.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000368:Aged; D000375:Aging; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Age groups; Elderly; Gamma knife; Intracranial arteriovenous malformations; Radiosurgery; Stroke; Vascular malformations