A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery

• Published in: International journal of radiation oncology, biology, physics Vol. 44; no. 1; p. 67
• Main Authors: Flickinger, J C, Kondziolka, D, Lunsford, L D, Pollock, B E, Yamamoto, M, Gorman, D A, Schomberg, P J, Sneed, P, Larson, D, Smith, V, McDermott, M W, Miyawaki, L, Chilton, J, Morantz, R A, Young, B, Jokura, H, Liscak, R
• Format: Journal Article
• Language: English
• Published: United States 01-04-1999
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Analysis of Variance; Brain - drug effects; Brain - radiation effects; Brain Diseases - etiology; Cranial Nerve Diseases - etiology; Cysts - etiology; Humans; Intracranial Arteriovenous Malformations - surgery; Male; Middle Aged; Proportional Hazards Models; Radiation Injuries - complications; Radiation Injuries - drug therapy; Radiosurgery - adverse effects; Radiotherapy Dosage; Seizures - etiology; Severity of Illness Index
• ISSN: 0360-3016
• DOI: 10.1016/S0360-3016(98)00518-5

To better understand radiation complications of arteriovenous malformation (AVM) radiosurgery and factors affecting their resolution.
AVM patients (102/1255) who developed neurological sequelae after radiosurgery were studied. The median AVM marginal dose (Dmin) was 19 Gy (range: 10-35). The median volume was 5.7 cc (range: 0.26-143). Median follow-up was 34 months (range: 9-140).
Complications consisted of 80/102 patients with evidence of radiation injury to the brain parenchyma (7 also with cranial nerve deficits, 12 also with seizures, 5 with cyst formation), 12/102 patients with isolated cranial neuropathies, and 10/102 patients with only new or worsened seizures. Severity was classified as minimal in 39 patients, mild in 40, disabling in 21, and fatal in 2 patients. Symptoms resolved completely in 42 patients for an actuarial resolution rate of 54% +/- 7% at 3 years post-onset. Multivariate analysis identified significantly greater symptom resolution in patients with no prior history of hemorrhage (p = 0.01, 66% vs. 41%), and in patients with symptoms of minimal severity: headache or seizure as the only sequelae of radiosurgery (p < 0.0001, 88% vs. 34%).
Late sequelae of radiosurgery manifest in varied ways. Further long-term studies of these problems are needed that take into account symptom severity and prior hemorrhage history.