Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations

BACKGROUND: Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation.

METHODS: This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome.

RESULTS: The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; >4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P<0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P<0.001) were associated with reduced probability of favorable outcome.

CONCLUSIONS: Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.

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Work Title Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations
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Open Access
Creators
  1. Georgios Mantziaris
  2. Stylianos Pikis
  3. Chloe Dumot
  4. Samantha Dayawansa
  5. Roman Liščák
  6. Jaromir May
  7. Cheng Chia Lee
  8. Huai Che Yang
  9. Nuria Martinez Moreno
  10. Roberto Martinez Álvarez
  11. L. Dade Lunsford
  12. Ajay Niranjan
  13. Zhishuo Wei
  14. Priyanka Srinivasan
  15. Lilly W. Tang
  16. Ahmed M. Nabeel
  17. Wael A. Reda
  18. Sameh R. Tawadros
  19. Khaled Abdelkarim
  20. Amr M.N. El-Shehaby
  21. Reem M. Emad
  22. Ahmed Hesham Elazzazi
  23. Selcuk Peker
  24. Yavuz Samanci
  25. Varun Padmanaban
  26. Francis J. Jareczek
  27. James McInerney
  28. Kevin M. Cockroft
  29. David Mathieu
  30. Salman Aldakhil
  31. Juan Diego Alzate
  32. Douglas Kondziolka
  33. Manjul Tripathi
  34. Joshua D. Palmer
  35. Rituraj Upadhyay
  36. Michelle Lin
  37. Gabriel Zada
  38. Cheng Yu
  39. Christopher P. Cifarelli
  40. Daniel T. Cifarelli
  41. Zhiyuan Xu
  42. Jason P. Sheehan
Keyword
  1. Intracranial arteriovenous malformation
  2. Probability
  3. Radiosurgery
  4. Stroke
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Stroke
Publication Date June 23, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.1161/STROKEAHA.123.042515
Deposited March 04, 2025

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Version 1
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  • Created

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added mantziaris-et-al-2023-outcome-evaluation-of-repeat-stereotactic-radiosurgery-for-cerebral-arteriovenous-malformations.pdf

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Georgios Mantziaris

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Stylianos Pikis

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Chloe Dumot

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Samantha Dayawansa

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Roman Liščák

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Jaromir May

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Cheng Chia Lee

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Huai Che Yang

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Nuria Martinez Moreno

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Roberto Martinez Álvarez

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator L. Dade Lunsford

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Ajay Niranjan

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Zhishuo Wei

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Priyanka Srinivasan

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Lilly W. Tang

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Ahmed M. Nabeel

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Wael A. Reda

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Sameh R. Tawadros

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Khaled Abdelkarim

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Amr M.N. El-Shehaby

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Reem M. Emad

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Ahmed Hesham Elazzazi

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Selcuk Peker

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Yavuz Samanci

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Varun Padmanaban

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Francis J. Jareczek

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator James McInerney

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Kevin M. Cockroft

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator David Mathieu

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Salman Aldakhil

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Juan Diego Alzate

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Douglas Kondziolka

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Manjul Tripathi

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Joshua D. Palmer

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Rituraj Upadhyay

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Michelle Lin

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Gabriel Zada

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Cheng Yu

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Christopher P. Cifarelli

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Daniel T. Cifarelli

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Zhiyuan Xu

    March 04, 2025 14:42 by Researcher Metadata Database

  • Added Creator Jason P. Sheehan

    March 04, 2025 14:42 by Researcher Metadata Database

  • Published

    March 04, 2025 14:42 by Researcher Metadata Database

  • Updated

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

  • Updated Keyword, Description, Publication Date Show Changes

    March 05, 2025 11:37 by avs5190

    Keyword
    • Intracranial arteriovenous malformation, Probability, Radiosurgery, Stroke
    Description
    • BACKGROUND: Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation. METHODS: This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome. RESULTS: The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; &gt;4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P&lt;0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P&lt;0.001) were associated with reduced probability of favorable outcome. CONCLUSIONS: Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.
    • BACKGROUND: Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation.
    • METHODS: This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome.
    • RESULTS: The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; &gt;4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P&lt;0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P&lt;0.001) were associated with reduced probability of favorable outcome.
    • CONCLUSIONS: Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.
    Publication Date
    • 2023-08-01
    • 2023-06-23