• World Neurosurg · Sep 2024

    Serum Vascular Endothelial Growth Factor and Endostatin as an adjunct to clinical decision making in managing radiation induced changes post Gamma Knife Radiosurgery in Spetzler Martin Grade 3 Arterio-venous Malformations patients: A pilot Study.

    • Shweta Kedia, Sarvesh Goyal, Kanwaljeet Garg, Manoj Phalak, Arul Selvi, Anand Kumar, Deepak Agarwal, Manmohan Singh, Rajinder Kumar, and Shashank Sharad Kale.
    • Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drshwetakedia@gmail.com.
    • World Neurosurg. 2024 Sep 1; 189: e864e871e864-e871.

    BackgroundRadiation induced changes (RIC) are the most common complications observed post Gamma Knife radiosurgery (GKRS) and may be observed within 6-18 months post procedure. It has been observed that almost one-third of RICs are symptomatic and half of them are persistent. There is no way to predict which patients will develop these changes and to what extent.MethodsThis was a prospective analytical pilot study with the aim of understanding the role of serum vascular endothelial growth factor (VEGF) and endostatin as predictive factors for clinically symptomatic RIC in intracranial arteriovenous malformations (AVMs) of Spetzler Martin (SM) grade 3 being managed with primary GKRS.ResultsA total of 15 patients were analyzed; 60% of them had a history of bleed. The median volume of AVM nidus was 4.36 mL. One-third of the patients had no imaging changes suggestive of RIC at 1 year follow-up and 2 of the patients had symptomatic RIC needing intervention. Before GKRS, the median values of serum concentration of endostatin and VEGF were 34.98 ng/mL and 168.37 pg/mL, respectively. The serum values of VEGF at 1 month post GKRS was much lower than the pre-GKRS values but not found to be predictive of RIC. No correlation could be observed with the levels of serum endostatin and RIC.ConclusionsSome patients may develop resistant edema and necrosis post GKRS for intracranial AVMs, which may warrant medical and surgical intervention. Serum biomarkers like VEGF and endostatin may vary in the post GKRS period and can be used to identify at-risk cases, however more studies are needed to decide on appropriate time of sampling and identify clinically relevant predictive factors.Copyright © 2024 Elsevier Inc. All rights reserved.

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