Comparison of Repeat Versus Initial Stereotactic Radiosurgery for Intracranial Arteriovenous Malformations: A Retrospective Multicenter Matched Cohort Study

BACKGROUND AND OBJECTIVES: Studies comparing neurological and radiographic outcomes of repeat to initial stereotactic radiosurgery (SRS) intracranial arteriovenous malformations are scarce. Our aim was to perform a retrospective matched comparison of patients initially treated with SRS with those undergoing a second radiosurgical procedure.

METHODS: We collected data from arteriovenous malformations managed in 21 centers that underwent initial and repeated radiosurgery from 1987 to 2022. Based on arteriovenous malformations volume, margin dose, deep venous drainage, deep, and critical location, we matched 1:1 patients who underwent an initial SRS for treatment-naive arteriovenous malformations and a group with repeated SRS treatment.

RESULTS: After the selection process, our sample consisted of 328 patients in each group. Obliteration in the initial SRs group was 35.8% at 3 and 56.7% at 5 years post-SRS, while the repeat SRS group showed obliteration rates of 33.9% at 3 years and 58.6% at 5 years, without statistically significant differences (P = .75 and P = .88, respectively). There were no statistically significant differences between the 2 groups for obliteration rates (hazard ratio = 0.93; 95% CI, 0.77-1.13; P = .5), overall radiation-induced changes (RIC) (OR = 1.1; 95% CI, 0.75-1.6; P = .6), symptomatic RIC (OR = 0.78; 95% CI, 0.4-1.5; P = .4), and post-SRS hemorrhage (OR = 0.68; 95% CI; P = .3).

CONCLUSION: In matched cohort analysis, a second SRS provides comparable outcomes in obliteration and RIC compared with the initial SRS. Dose reduction on repeat SRS may not be warranted.

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Work Title Comparison of Repeat Versus Initial Stereotactic Radiosurgery for Intracranial Arteriovenous Malformations: A Retrospective Multicenter Matched Cohort Study
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Open Access
Creators
  1. Eduardo Orrego Gonzalez
  2. Georgios Mantziaris
  3. Ahmed Shaaban
  4. Robert M. Starke
  5. Dale Ding
  6. John Y.K. Lee
  7. David Mathieu
  8. Douglas Kondziolka
  9. Caleb Feliciano
  10. Inga S. Grills
  11. Gene H. Barnett
  12. L. Dade Lunsford
  13. Roman Liščák
  14. Cheng Chia Lee
  15. Roberto Martinez Álvarez
  16. Selcuk Peker
  17. Yavuz Samanci
  18. Kevin M. Cockroft
  19. Manjul Tripathi
  20. Joshua D. Palmer
  21. Gabriel Zada
  22. Christopher P. Cifarelli
  23. Ahmed M. Nabeel
  24. Stylianos Pikis
  25. Jason P. Sheehan
Keyword
  1. Arteriovenous malformation
  2. Stereotactic radiosurgery
  3. Obliteration
  4. Stroke
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Neurosurgery
Publication Date April 16, 2024
Publisher Identifier (DOI)
  1. https://doi.org/10.1227/neu.0000000000002950
Deposited March 04, 2025

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  • Created

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added comparison_of_repeat_versus_initial_stereotactic.21.pdf

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Eduardo Orrego Gonzalez

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Georgios Mantziaris

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Ahmed Shaaban

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Robert M. Starke

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Dale Ding

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator John Y.K. Lee

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator David Mathieu

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Douglas Kondziolka

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Caleb Feliciano

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Inga S. Grills

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Gene H. Barnett

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator L. Dade Lunsford

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Roman Liščák

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Cheng Chia Lee

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Roberto Martinez Álvarez

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Selcuk Peker

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Yavuz Samanci

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Kevin M. Cockroft

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Manjul Tripathi

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Joshua D. Palmer

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Gabriel Zada

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Christopher P. Cifarelli

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Ahmed M. Nabeel

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Stylianos Pikis

    March 04, 2025 16:50 by Researcher Metadata Database

  • Added Creator Jason P. Sheehan

    March 04, 2025 16:50 by Researcher Metadata Database

  • Published

    March 04, 2025 16:50 by Researcher Metadata Database

  • Updated

    March 04, 2025 21:05 by [unknown user]

  • Updated Keyword, Description, Publication Date Show Changes

    March 05, 2025 11:02 by avs5190

    Keyword
    • Arteriovenous malformation, Stereotactic radiosurgery, Obliteration, Stroke
    Description
    • BACKGROUND AND OBJECTIVES: Studies comparing neurological and radiographic outcomes of repeat to initial stereotactic radiosurgery (SRS) intracranial arteriovenous malformations are scarce. Our aim was to perform a retrospective matched comparison of patients initially treated with SRS with those undergoing a second radiosurgical procedure. METHODS: We collected data from arteriovenous malformations managed in 21 centers that underwent initial and repeated radiosurgery from 1987 to 2022. Based on arteriovenous malformations volume, margin dose, deep venous drainage, deep, and critical location, we matched 1:1 patients who underwent an initial SRS for treatment-naive arteriovenous malformations and a group with repeated SRS treatment. RESULTS: After the selection process, our sample consisted of 328 patients in each group. Obliteration in the initial SRs group was 35.8% at 3 and 56.7% at 5 years post-SRS, while the repeat SRS group showed obliteration rates of 33.9% at 3 years and 58.6% at 5 years, without statistically significant differences (P = .75 and P = .88, respectively). There were no statistically significant differences between the 2 groups for obliteration rates (hazard ratio = 0.93; 95% CI, 0.77-1.13; P = .5), overall radiation-induced changes (RIC) (OR = 1.1; 95% CI, 0.75-1.6; P = .6), symptomatic RIC (OR = 0.78; 95% CI, 0.4-1.5; P = .4), and post-SRS hemorrhage (OR = 0.68; 95% CI; P = .3). CONCLUSION: In matched cohort analysis, a second SRS provides comparable outcomes in obliteration and RIC compared with the initial SRS. Dose reduction on repeat SRS may not be warranted.
    • BACKGROUND AND OBJECTIVES: Studies comparing neurological and radiographic outcomes of repeat to initial stereotactic radiosurgery (SRS) intracranial arteriovenous malformations are scarce. Our aim was to perform a retrospective matched comparison of patients initially treated with SRS with those undergoing a second radiosurgical procedure.
    • METHODS: We collected data from arteriovenous malformations managed in 21 centers that underwent initial and repeated radiosurgery from 1987 to 2022. Based on arteriovenous malformations volume, margin dose, deep venous drainage, deep, and critical location, we matched 1:1 patients who underwent an initial SRS for treatment-naive arteriovenous malformations and a group with repeated SRS treatment.
    • RESULTS: After the selection process, our sample consisted of 328 patients in each group. Obliteration in the initial SRs group was 35.8% at 3 and 56.7% at 5 years post-SRS, while the repeat SRS group showed obliteration rates of 33.9% at 3 years and 58.6% at 5 years, without statistically significant differences (P = .75 and P = .88, respectively). There were no statistically significant differences between the 2 groups for obliteration rates (hazard ratio = 0.93; 95% CI, 0.77-1.13; P = .5), overall radiation-induced changes (RIC) (OR = 1.1; 95% CI, 0.75-1.6; P = .6), symptomatic RIC (OR = 0.78; 95% CI, 0.4-1.5; P = .4), and post-SRS hemorrhage (OR = 0.68; 95% CI; P = .3).
    • CONCLUSION: In matched cohort analysis, a second SRS provides comparable outcomes in obliteration and RIC compared with the initial SRS. Dose reduction on repeat SRS may not be warranted.
    Publication Date
    • 2024-10-01
    • 2024-04-16