• José Luis Thenier-Villa, Raúl Alejandro Galárraga-Campoverde, Rosa María Martínez Rolán, Adolfo Ramón De La Lama Zaragoza, Pedro Martínez Cueto, Víctor Muñoz Garzón, Manuel Salgado Fernández, and Cesáreo Conde Alonso.
• Department of Neurosurgery, University Hospital Complex of Vigo-Álvaro Cunqueiro Hospital, Vigo, Pontevedra, Spain. Electronic address: jose.luis.thenier.villa@sergas.es.
• World Neurosurg. 2017 Jul 1; 103: 291-302.

BackgroundLinear accelerator stereotactic radiosurgery is one of the modalities available for the treatment of central nervous system arteriovenous malformations (AVMs). The aim of this study was to describe our 15-year experience with this technique in a single tertiary center and the analysis of outcome-related factors.MethodsFrom 1998 to 2013, 195 patients were treated with linear accelerator-based radiosurgery; we conducted a retrospective study collecting patient- and AVM-related variables. Treatment outcomes were obliteration, posttreatment hemorrhage, symptomatic radiation-induced changes, and 3-year neurologic status. We also analyzed prognostic factors of each outcome and predictability analysis of 5 scales: Spetzler-Martin grade, Lawton-Young supplementary and Lawton combined scores, radiosurgery-based AVM score, Virginia Radiosurgery AVM Scale, and Heidelberg score.ResultsOverall obliteration rate was 81%. Nidus diameter and venous drainage were predictive of obliteration (P < 0.05), ruptured status and previous embolization were not related to rate of obliteration, and low-grade AVMs had higher obliteration rates. Posttreatment hemorrhage incidence was 8.72%; nidus diameter was the only predictor (P = 0.05). Symptomatic radiation-induced changes occurred in 11.79% of patients and were significantly associated with unruptured status (P < 0.05). Treatment success as a composite measure was obtained in 70.77% of patients. Receiver operating characteristic curves were presented for each scoring system and outcome measure; best area under the curve was 0.687 for Lawton combined score in the obliteration outcome.ConclusionsIn the long-term, linear accelerator-based radiosurgery is a useful, valid, effective, and safe modality for treatment of brain AVMs.Copyright © 2017 Elsevier Inc. All rights reserved.

30 keywords...

hide…