Effect of cerebral arteriovenous malformation location on outcomes of repeat, single-fraction stereotactic radiosurgery: a matched-cohort analysis

OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes.

METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose.

RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference −18%, 95% CI −30.9 to −5.8%, p = 0.004) and AVM obliteration (probability difference –18%, 95% CI –30.1% to −6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI –2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI –10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047).

CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.

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Work Title Effect of cerebral arteriovenous malformation location on outcomes of repeat, single-fraction stereotactic radiosurgery: a matched-cohort analysis
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Open Access
Creators
  1. Georgios Mantziaris
  2. Stylianos Pikis
  3. Chloe Dumot
  4. Sam Dayawansa
  5. Roman Liscak
  6. Jaromir May
  7. Cheng Chia Lee
  8. Huai Che Yang
  9. Nuria Martínez 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 Abdel Karim
  20. Amr M.N. El-Shehaby
  21. Reem M. Emad Eldin
  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. Ahmed Shaaban
  42. Zhiyuan Xu
  43. Jason P. Sheehan
Keyword
  1. Arteriovenous malformation
  2. Intracranial hemorrhage
  3. Residual
  4. Stereotactic radiosurgery
  5. Vascular disorders
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Journal of Neurosurgery
Publication Date December 22, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.3171/2023.10.JNS231957
Deposited March 04, 2025

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Version 1
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  • Created

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added AVMlocation_stereotactic_radiosurgery.pdf

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Georgios Mantziaris

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Stylianos Pikis

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Chloe Dumot

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Sam Dayawansa

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Roman Liscak

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Jaromir May

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Cheng Chia Lee

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Huai Che Yang

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Nuria Martínez Moreno

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Roberto Martinez Álvarez

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator L. Dade Lunsford

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ajay Niranjan

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Zhishuo Wei

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Priyanka Srinivasan

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Lilly W. Tang

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ahmed M. Nabeel

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Wael A. Reda

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Sameh R. Tawadros

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Khaled Abdel Karim

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Amr M.N. El-Shehaby

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Reem M. Emad Eldin

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ahmed Hesham Elazzazi

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Selcuk Peker

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Yavuz Samanci

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Varun Padmanaban

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Francis J. Jareczek

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator James McInerney

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Kevin M. Cockroft

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator David Mathieu

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Salman Aldakhil

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Juan Diego Alzate

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Douglas Kondziolka

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Manjul Tripathi

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Joshua D. Palmer

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Rituraj Upadhyay

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Michelle Lin

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Gabriel Zada

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Cheng Yu

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Christopher P. Cifarelli

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Daniel T. Cifarelli

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Ahmed Shaaban

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Zhiyuan Xu

    March 04, 2025 16:47 by Researcher Metadata Database

  • Added Creator Jason P. Sheehan

    March 04, 2025 16:47 by Researcher Metadata Database

  • Published

    March 04, 2025 16:47 by Researcher Metadata Database

  • Updated

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

  • Updated Keyword, Description, Publication Date Show Changes

    March 05, 2025 11:09 by avs5190

    Keyword
    • Arteriovenous malformation, Intracranial hemorrhage, Residual, Stereotactic radiosurgery, Vascular disorders
    Description
    • OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes. METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose. RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference −18%, 95% CI −30.9 to −5.8%, p = 0.004) and AVM obliteration (probability difference –18%, 95% CI –30.1% to −6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI –2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI –10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047). CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.
    • OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes.
    • METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose.
    • RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference −18%, 95% CI −30.9 to −5.8%, p = 0.004) and AVM obliteration (probability difference –18%, 95% CI –30.1% to −6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI –2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI –10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047).
    • CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.
    Publication Date
    • 2024-06-01
    • 2023-12-22