title: Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations.
abstract: OBJECTIVE Patients with cerebral arteriovenous malformations (AVMs) commonly present with seizure. Seizure outcomes in patients treated with stereotactic radiosurgery (SRS) are poorly defined. A case series of patients with cerebral AVMs treated with SRS is presented to evaluate long-term seizure outcome. METHODS A retrospective review of the medical record was performed, identifying 204 consecutive patients with AVMs treated with SRS between January 1991 and June 2012. Clinical and radiographic data were evaluated. Seizure outcome was measured using the Engel Epilepsy Surgery Outcome Scale. Mean duration of follow-up was 37.1 months (SD 38.3 months) with a minimum follow-up period of 1 month. RESULTS Of the 204 patients with cerebral AVMs treated with SRS, 78 patients (38.2%) presented with seizures and 49 of those patients were treated with antiepileptic drugs (AEDs). Following SRS, 63 (80.8%) of the 78 patients who had had seizures prior to SRS were seizure-free at a mean follow-up time of 37.2 months (SD 41.3 months). Of the 49 patients who had been treated with AEDs, 17 were still taking AEDs at last follow-up. Of the 126 patients who did not present with seizures prior to treatment with SRS, only 5 patients (4.0%) had seizures in the post-SRS period. There was no significant correlation between post-SRS seizure status and patient demographic features, comorbidities, AVM characteristics, history of operative intervention, pre- or posttreatment hemorrhage, or radiographic degree of AVM resolution. CONCLUSIONS Stereotactic radiosurgery for treatment of cerebral AVMs is effective at providing long-term control of seizures. A substantial number of patients who were treated with SRS were not only seizure free at their last follow-up, but had been successfully weaned from antiepileptic medications.
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Ditty
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Nidal B
authors.initials: NB
authors.lastname: Omar
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Miller
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Kicielinski
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Winfield S
authors.initials: WS
authors.lastname: Fisher
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: AED = antiepileptic drug; AVM; AVM = arteriovenous malformation; CTA = CT angiography; DSA = digital subtraction angiography; ICH = intracerebral hemorrhage; SRS = stereotactic radiosurgery; arteriovenous malformation; seizure; stereotactic radiosurgery; vascular disorders