Is stereotactic radiosurgery the best treatment option for patients with a radiosurgery-based arteriovenous malformation score ≤1?

Anthony M. Burrow, Michael J. Link, Bruce E. Pollock

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Objective The best management of patients with brain arteriovenous malformations (BAVM) is controversial. The radiosurgery-based arteriovenous malformation (AVM) score (RBAS) was developed to predict outcomes for patients with BAVM having stereotactic radiosurgery (SRS).

Methods The RBAS is calculated for patients with BAVM having SRS at our center as part of our prospectively maintained SRS database (RBAS = [0.1] [AVM volume; cm3] + [0.02] [patient age; years] + [0.5] [AVM location; 0 = cerebral/cerebellar hemispheres/corpus callosum, 1 = basal ganglia/thalamus/brainstem]). Review of the SRS database from 1990 to 2009 identified 80 patients with a RBAS ≤&1 and at least 1 year of follow-up. The primary end point of the study was a decline in modified Rankin Score. The mean follow-up after SRS was 68 months (range, 12-133).

Conclusions SRS provided a high rate of obliteration at very low risk for patients with BVAM with a RBAS ≤;1. Patient outcomes after SRS are likely equivalent to resection for younger patients with small-volume BAVM who do not require a craniotomy for clot removal.

Results The mean patient age was 25.2 years (range, 7-44). Seventy-six patients (95%) had superficially located BAVMs; the mean BAVM volume was 2.3 cm;bsupesup& (range, 0.1-8.0). The mean RBAS was 0.76 (range, 0.21-1.00). The patients' MRS before SRS was 0 (n = 52, 65%), 1 (n = 24, 30%), 2 (n = 3, 4%), and 3 (n = 1, 1%). BAVM obliteration was confirmed in 92% of patients with follow-up beyond 3 years (70/76; 95% confidence interval 84%-97%). No patient had a hemorrhage or a radiation-related complication after SRS. The observed rate of modified Rankin Score decrease after SRS was 0% (0/80; 95% confidence interval 0%-6%).

Original languageEnglish (US)
Pages (from-to)1144-1147
Number of pages4
JournalWorld Neurosurgery
Volume82
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Radiosurgery
Arteriovenous Malformations
Therapeutics
Brain
Databases
Confidence Intervals
Corpus Callosum
Craniotomy
Cerebrum
Basal Ganglia
Thalamus
Brain Stem

Keywords

  • Arteriovenous malformation
  • Grading scale
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Is stereotactic radiosurgery the best treatment option for patients with a radiosurgery-based arteriovenous malformation score ≤1? / Burrow, Anthony M.; Link, Michael J.; Pollock, Bruce E.

In: World Neurosurgery, Vol. 82, No. 6, 01.12.2014, p. 1144-1147.

Research output: Contribution to journalReview article

Burrow, Anthony M. ; Link, Michael J. ; Pollock, Bruce E. / Is stereotactic radiosurgery the best treatment option for patients with a radiosurgery-based arteriovenous malformation score ≤1?. In: World Neurosurgery. 2014 ; Vol. 82, No. 6. pp. 1144-1147.
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title = "Is stereotactic radiosurgery the best treatment option for patients with a radiosurgery-based arteriovenous malformation score ≤1?",
abstract = "Objective The best management of patients with brain arteriovenous malformations (BAVM) is controversial. The radiosurgery-based arteriovenous malformation (AVM) score (RBAS) was developed to predict outcomes for patients with BAVM having stereotactic radiosurgery (SRS).Methods The RBAS is calculated for patients with BAVM having SRS at our center as part of our prospectively maintained SRS database (RBAS = [0.1] [AVM volume; cm3] + [0.02] [patient age; years] + [0.5] [AVM location; 0 = cerebral/cerebellar hemispheres/corpus callosum, 1 = basal ganglia/thalamus/brainstem]). Review of the SRS database from 1990 to 2009 identified 80 patients with a RBAS ≤&1 and at least 1 year of follow-up. The primary end point of the study was a decline in modified Rankin Score. The mean follow-up after SRS was 68 months (range, 12-133).Conclusions SRS provided a high rate of obliteration at very low risk for patients with BVAM with a RBAS ≤;1. Patient outcomes after SRS are likely equivalent to resection for younger patients with small-volume BAVM who do not require a craniotomy for clot removal.Results The mean patient age was 25.2 years (range, 7-44). Seventy-six patients (95{\%}) had superficially located BAVMs; the mean BAVM volume was 2.3 cm;bsupesup& (range, 0.1-8.0). The mean RBAS was 0.76 (range, 0.21-1.00). The patients' MRS before SRS was 0 (n = 52, 65{\%}), 1 (n = 24, 30{\%}), 2 (n = 3, 4{\%}), and 3 (n = 1, 1{\%}). BAVM obliteration was confirmed in 92{\%} of patients with follow-up beyond 3 years (70/76; 95{\%} confidence interval 84{\%}-97{\%}). No patient had a hemorrhage or a radiation-related complication after SRS. The observed rate of modified Rankin Score decrease after SRS was 0{\%} (0/80; 95{\%} confidence interval 0{\%}-6{\%}).",
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N2 - Objective The best management of patients with brain arteriovenous malformations (BAVM) is controversial. The radiosurgery-based arteriovenous malformation (AVM) score (RBAS) was developed to predict outcomes for patients with BAVM having stereotactic radiosurgery (SRS).Methods The RBAS is calculated for patients with BAVM having SRS at our center as part of our prospectively maintained SRS database (RBAS = [0.1] [AVM volume; cm3] + [0.02] [patient age; years] + [0.5] [AVM location; 0 = cerebral/cerebellar hemispheres/corpus callosum, 1 = basal ganglia/thalamus/brainstem]). Review of the SRS database from 1990 to 2009 identified 80 patients with a RBAS ≤&1 and at least 1 year of follow-up. The primary end point of the study was a decline in modified Rankin Score. The mean follow-up after SRS was 68 months (range, 12-133).Conclusions SRS provided a high rate of obliteration at very low risk for patients with BVAM with a RBAS ≤;1. Patient outcomes after SRS are likely equivalent to resection for younger patients with small-volume BAVM who do not require a craniotomy for clot removal.Results The mean patient age was 25.2 years (range, 7-44). Seventy-six patients (95%) had superficially located BAVMs; the mean BAVM volume was 2.3 cm;bsupesup& (range, 0.1-8.0). The mean RBAS was 0.76 (range, 0.21-1.00). The patients' MRS before SRS was 0 (n = 52, 65%), 1 (n = 24, 30%), 2 (n = 3, 4%), and 3 (n = 1, 1%). BAVM obliteration was confirmed in 92% of patients with follow-up beyond 3 years (70/76; 95% confidence interval 84%-97%). No patient had a hemorrhage or a radiation-related complication after SRS. The observed rate of modified Rankin Score decrease after SRS was 0% (0/80; 95% confidence interval 0%-6%).

AB - Objective The best management of patients with brain arteriovenous malformations (BAVM) is controversial. The radiosurgery-based arteriovenous malformation (AVM) score (RBAS) was developed to predict outcomes for patients with BAVM having stereotactic radiosurgery (SRS).Methods The RBAS is calculated for patients with BAVM having SRS at our center as part of our prospectively maintained SRS database (RBAS = [0.1] [AVM volume; cm3] + [0.02] [patient age; years] + [0.5] [AVM location; 0 = cerebral/cerebellar hemispheres/corpus callosum, 1 = basal ganglia/thalamus/brainstem]). Review of the SRS database from 1990 to 2009 identified 80 patients with a RBAS ≤&1 and at least 1 year of follow-up. The primary end point of the study was a decline in modified Rankin Score. The mean follow-up after SRS was 68 months (range, 12-133).Conclusions SRS provided a high rate of obliteration at very low risk for patients with BVAM with a RBAS ≤;1. Patient outcomes after SRS are likely equivalent to resection for younger patients with small-volume BAVM who do not require a craniotomy for clot removal.Results The mean patient age was 25.2 years (range, 7-44). Seventy-six patients (95%) had superficially located BAVMs; the mean BAVM volume was 2.3 cm;bsupesup& (range, 0.1-8.0). The mean RBAS was 0.76 (range, 0.21-1.00). The patients' MRS before SRS was 0 (n = 52, 65%), 1 (n = 24, 30%), 2 (n = 3, 4%), and 3 (n = 1, 1%). BAVM obliteration was confirmed in 92% of patients with follow-up beyond 3 years (70/76; 95% confidence interval 84%-97%). No patient had a hemorrhage or a radiation-related complication after SRS. The observed rate of modified Rankin Score decrease after SRS was 0% (0/80; 95% confidence interval 0%-6%).

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