Surgical management of adverse radiation effects after Gamma Knife radiosurgery for cerebral arteriovenous malformations: a population-based cohort study.
World Neurosurg. 2018 Mar 20;:
Authors: Meneghelli P, Pasqualin A, Zampieri P, Longhi M, Foroni R, Sini A, Tommasi N, Nicolato A
Abstract
OBJECTIVE: The goal of this study is to report our experience in the surgical treatment of cAVMs related permanent symptomatic adverse radiation effects (PSARE), in order to clarify an appropriate surgical management and identify the risk factors related to their development.
METHODS: We evaluated a total of 549 patients treated with Gamma Knife radiosurgery (GKRS) for cAVMs with a follow-up of at least 8 years. Univariate and multivariate analyses were used to test different risk factors related to the development of PSARE. We retrospectively reviewed the records of these patients to analyze the clinical outcome.
RESULTS: Fourteen patients (2.5%) developed PSARE and were submitted to surgery. Higher average treated volume represents a significant risk factors for the development of PSARE (p<0.05); on the other hand, older age and higher average dose reduce the risk of PSARE (p<0.05). A favorable clinical outcome was achieved in 13 patients (93%) after surgery; in one patient, the unfavorable outcome was due to hemorrhage that occurred months after GKRS. Serial MRI scans following either surgical removal of the nodule or Ommaya reservoir positioning showed progressive reduction of brain edema in all cases.
CONCLUSIONS: The management of PSARE is controversial, especially for cAVMs treated with SRS. Surgical removal is rarely needed, but - if unavoidable - it can be a valuable option in experienced hands. A careful preoperative planning is always necessary in order to detect pathological blood flow through the PSARE.
PMID: 29572169 [PubMed - as supplied by publisher]
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