Analysis of nidus obliteration rates after gamma knife surgery for arteriovenous malformations based on long-term follow-up data: the University of Tokyo experience

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  • 1 Departments of Neurosurgery and Radiation Oncology, The University of Tokyo Hospital, Tokyo, Japan
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Object. A large number of clinical studies have been made on treatment outcomes of radiosurgery for arteriovenous malformations (AVMs), but the reported obliteration rates following this treatment vary significantly, perhaps reflecting the different methods and timings of the imaging studies used.

Methods. The authors retrospectively analyzed their experience with gamma knife surgery in 400 patients with AVMs (follow-up period 1–135 months, median 65 months), with special reference to the imaging modality used in each case. The calculated obliteration rates varied from 68.2 to 92%, depending on imaging modality and timing of evaluation. When only unquestionable imaging data such as demonstrations of a residual nidus on computerized tomography (CT) or magnetic resonance (MR) images or findings on angiograms were used in the calculation, the obliteration rates were 72% at 3 years and 87.3% at 5 years. Factors leading to a better obliteration rate were previous hemorrhage (p = 0.0084), smaller nidus (p = 0.0023), and higher radiation dose to the lesion's margin (p = 0.0495), as determined in a multivariate analysis. Factors leading to an earlier obliteration of the nidus were male sex (p = 0.0001), previous hemorrhage (p = 0.0039), smaller nidus diameter (p = 0.0006), and dose planning using angiography alone (p = 0.0201).

Conclusions. After the introduction of CT and MR images into dose planning, the conformity and selectivity of dosimetry improved remarkably, although the latency intervals until obliteration were prolonged. Imaging outcomes for AVMs should be evaluated using data provided by longer follow-up periods. The timing of additional treatments for residual AVMs should be decided cautiously, considering the size of the AVM, the patient age and sex, and the history of hemorrhage before radiosurgery.

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Contributor Notes

Address reprint requests to: Masahiro Shin, M.D., Department of Neurosurgery, University of Tokyo Hospital, 7–3–1 Hongo, Bunkyoku, Tokyo, 113–8655, Japan. email address: shinmasa@ka2.so-net.ne.jp.
  • 1.

    Abdulrauf SI, , Malik GM, & Awad IA: Spontaneous angiographic obliteration of cerebral arteriovenous malformations. Neurosurgery 44:280288, 1999 Abdulrauf SI, Malik GM, Awad IA: Spontaneous angiographic obliteration of cerebral arteriovenous malformations. Neurosurgery 44:280–288, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Bendszus M, , Koltzenburg M, & Burger R, et al. : Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 354:15941597, 1999 Bendszus M, Koltzenburg M, Burger R, et al: Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 354:1594–1597, 1999

    • Search Google Scholar
    • Export Citation
  • 3.

    Bhatnagar A, , Flickinger JC, & Kondziolka D, et al. : An analysis of the effects of smoking and other cardiovascular risk factors on obliteration rates after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 51:969973, 2001 Bhatnagar A, Flickinger JC, Kondziolka D, et al: An analysis of the effects of smoking and other cardiovascular risk factors on obliteration rates after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 51:969–973, 2001

    • Search Google Scholar
    • Export Citation
  • 4.

    Blatt DR, , Friedman WA, & Bova FJ: Modifications based on computed tomographic imaging in planning the radiosurgical treatment of arteriovenous malfromations. Neurosurgery 33:588596, 1993 Blatt DR, Friedman WA, Bova FJ: Modifications based on computed tomographic imaging in planning the radiosurgical treatment of arteriovenous malfromations. Neurosurgery 33:588–596, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Chang JH, , Chang JW, & Park YG, et al. : Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 93 (Suppl 3):96101, 2000 Chang JH, Chang JW, Park YG, et al: Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 93 (Suppl 3):96–101, 2000

    • Search Google Scholar
    • Export Citation
  • 6.

    Ellis TL, , Friedman WA, & Bova FJ, et al. : Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104110, 1998 Ellis TL, Friedman WA, Bova FJ, et al: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104–110, 1998

    • Search Google Scholar
    • Export Citation
  • 7.

    Flickinger JC, , Kondziolka D, & Maitz AH, et al. : An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiother Oncol 63:347354, 2002 Flickinger JC, Kondziolka D, Maitz AH, et al: An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiother Oncol 63:347–354, 2002

    • Search Google Scholar
    • Export Citation
  • 8.

    Fults D, & Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658662, 1984 Fults D, Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–662, 1984

    • Search Google Scholar
    • Export Citation
  • 9.

    Gallina P, , Merienne L, & Meder JF, et al. : Failure in radiosurgery treatment of cerebral arteriovenous malformations. Neurosurgery 42:9961004, 1998 Gallina P, Merienne L, Meder JF, et al: Failure in radiosurgery treatment of cerebral arteriovenous malformations. Neurosurgery 42:996–1004, 1998

    • Search Google Scholar
    • Export Citation
  • 10.

    Hadjipanayis CG, , Levy EI, & Niranjan A, et al. : Stereotactic radiosurgery for motor cortex region arteriovenous malformations. Neurosurgery 48:7077, 2001 Hadjipanayis CG, Levy EI, Niranjan A, et al: Stereotactic radiosurgery for motor cortex region arteriovenous malformations. Neurosurgery 48:70–77, 2001

    • Search Google Scholar
    • Export Citation
  • 11.

    Hashimoto T, , Mesa-Tejada R, & Quick CM, et al. : Evidence of increased endothelial cell turnover in brain arteriovenous malformations. Neurosurgery 49:124132, 2001 Hashimoto T, Mesa-Tejada R, Quick CM, et al: Evidence of increased endothelial cell turnover in brain arteriovenous malformations. Neurosurgery 49:124–132, 2001

    • Search Google Scholar
    • Export Citation
  • 12.

    Iwasa K, , Bernanke DH, & Smith RR, et al. : Nonmuscle arterial constriction after subarachnoid hemorrhage: role of growth factors derived from platelets. Neurosurgery 32:619624, 1993 Iwasa K, Bernanke DH, Smith RR, et al: Nonmuscle arterial constriction after subarachnoid hemorrhage: role of growth factors derived from platelets. Neurosurgery 32:619–624, 1993

    • Search Google Scholar
    • Export Citation
  • 13.

    Kaido T, , Hoshida T, & Uranishi R, et al. : Radiosurgery-induced brain tumor. Case report. J Neurosurg 95:710713, 2001 Kaido T, Hoshida T, Uranishi R, et al: Radiosurgery-induced brain tumor. Case report. J Neurosurg 95:710–713, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    Karlsson B, , Lax I, & Soderman M: Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 49:10451051, 2001 Karlsson B, Lax I, Soderman M: Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 49:1045–1051, 2001

    • Search Google Scholar
    • Export Citation
  • 15.

    Karlsson B, , Lindquist C, & Steiner L: Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425431, 1997 Karlsson B, Lindquist C, Steiner L: Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425–431, 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Krapf H, , Siekmann R, & Freudenstein D, et al. : Spontaneous occlusion of a cerebral arteriovenous malformation: angiography and MR imaging follow-up and review of the literature. AJNR 22:15561560, 2001 Krapf H, Siekmann R, Freudenstein D, et al: Spontaneous occlusion of a cerebral arteriovenous malformation: angiography and MR imaging follow-up and review of the literature. AJNR 22:1556–1560, 2001

    • Search Google Scholar
    • Export Citation
  • 17.

    Kurita H, , Kawamoto S, & Sasaki T, et al. : Results of radiosurgery for brain stem arteriovenous malformations. J Neurol Neurosurg Psychiatry 68:563570, 2000 Kurita H, Kawamoto S, Sasaki T, et al: Results of radiosurgery for brain stem arteriovenous malformations. J Neurol Neurosurg Psychiatry 68:563–570, 2000

    • Search Google Scholar
    • Export Citation
  • 18.

    Levy EI, , Niranjan A, & Thompson TP, et al. : Radiosurgery for childhood intracranial arteriovenous malformations. Neurosurgery 47:834842, 2000 Levy EI, Niranjan A, Thompson TP, et al: Radiosurgery for childhood intracranial arteriovenous malformations. Neurosurgery 47:834–842, 2000

    • Search Google Scholar
    • Export Citation
  • 19.

    Lindqvist M, , Karlsson B, & Guo WY, et al. : Angiographic long-term follow-up data for arteriovenous malformations previously proven to be obliterated after gamma knife radiosurgery. Neurosurgery 46:803810, 2000 Lindqvist M, Karlsson B, Guo WY, et al: Angiographic long-term follow-up data for arteriovenous malformations previously proven to be obliterated after gamma knife radiosurgery. Neurosurgery 46:803–810, 2000

    • Search Google Scholar
    • Export Citation
  • 20.

    Lunsford LD, , Kondziolka D, & Flickinger JC, et al. : Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512524, 1991 Lunsford LD, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512–524, 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Patel MC, , Hodgson TJ, & Kemeny AA, et al. : Spontaneous obliteration of pial arteriovenous malformations: a review of 27 cases. AJNR 22:531536, 2001 Patel MC, Hodgson TJ, Kemeny AA, et al: Spontaneous obliteration of pial arteriovenous malformations: a review of 27 cases. AJNR 22:531–536, 2001

    • Search Google Scholar
    • Export Citation
  • 22.

    Pik JHT, & Morgan MK: Microsurgery for small arteriovenous malformations of the brain: results in 110 consecutive patients. Neurosurgery 47:571577, 2000 Pik JHT, Morgan MK: Microsurgery for small arteriovenous malformations of the brain: results in 110 consecutive patients. Neurosurgery 47:571–577, 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Pikus HJ, , Beach ML, & Harbaugh RE: Microsurgical treatment of arteriovenous malformations: analysis and comparison with stereotactic radiosurgery. J Neurosurg 88:641646, 1998 Pikus HJ, Beach ML, Harbaugh RE: Microsurgical treatment of arteriovenous malformations: analysis and comparison with stereotactic radiosurgery. J Neurosurg 88:641–646, 1998

    • Search Google Scholar
    • Export Citation
  • 24.

    Pollock BE, , Flickinger JC, & Lunsford LD, et al. : Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 42:12391247, 1998 Pollock BE, Flickinger JC, Lunsford LD, et al: Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 42:1239–1247, 1998

    • Search Google Scholar
    • Export Citation
  • 25.

    Pollock BE, , Flickinger JC, & Lunsford LD, et al. : Hemorrhagic risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 38:652661, 1996 Pollock BE, Flickinger JC, Lunsford LD, et al: Hemorrhagic risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 38:652–661, 1996

    • Search Google Scholar
    • Export Citation
  • 26.

    Pollock BE, , Kondziolka D, & Flickinger JC, et al. : Magnetic resonance imaging: an accurate method to evaluate arteriovenous malformations after stereotactic radiosurgery. J Neurosurg 85:10441049, 1996 Pollock BE, Kondziolka D, Flickinger JC, et al: Magnetic resonance imaging: an accurate method to evaluate arteriovenous malformations after stereotactic radiosurgery. J Neurosurg 85:1044–1049, 1996

    • Search Google Scholar
    • Export Citation
  • 27.

    Pollock BE, , Kondziolka D, & Lunsford LD, et al. : Repeat stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. Neurosurgery 38:318324, 1996 Pollock BE, Kondziolka D, Lunsford LD, et al: Repeat stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. Neurosurgery 38:318–324, 1996

    • Search Google Scholar
    • Export Citation
  • 28.

    Sasaki T, , Kurita H, & Saito I, et al. : Arteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases. J Neurosurg 88:285292, 1998 Sasaki T, Kurita H, Saito I, et al: Arteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases. J Neurosurg 88:285–292, 1998

    • Search Google Scholar
    • Export Citation
  • 29.

    Schneider BF, , Eberhard DA, & Steiner LE: Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 87:352357, 1997 Schneider BF, Eberhard DA, Steiner LE: Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 87:352–357, 1997

    • Search Google Scholar
    • Export Citation
  • 30.

    Shin M, , Kawamoto S, & Kurita H, et al. : Retrospective analysis of a 10-year experience of stereotactic radiosurgery for arteriovenous malformations in children and adolescents. J Neurosurg 97:779784, 2002 Shin M, Kawamoto S, Kurita H, et al: Retrospective analysis of a 10-year experience of stereotactic radiosurgery for arteriovenous malformations in children and adolescents. J Neurosurg 97:779–784, 2002

    • Search Google Scholar
    • Export Citation
  • 31.

    Sisti MB, , Kader A, & Stein BM: Microsurgery for 67 intracranial arteriovenous malformations less than 3 cm in diameter. J Neurosurg 79:653660, 1993 Sisti MB, Kader A, Stein BM: Microsurgery for 67 intracranial arteriovenous malformations less than 3 cm in diameter. J Neurosurg 79:653–660, 1993

    • Search Google Scholar
    • Export Citation
  • 32.

    Smith HJ, , Strother CM, & Kikuchi Y, et al. : MR imaging in the management of supratentorial intracranial AVMs. AJR 150:11431153, 1988 Smith HJ, Strother CM, Kikuchi Y, et al: MR imaging in the management of supratentorial intracranial AVMs. AJR 150:1143–1153, 1988

    • Search Google Scholar
    • Export Citation
  • 33.

    Smith RR, , Clower BR, & Cruse JM, et al. : Constrictive structural elements in human cerebral arteries following aneurysmal subarachnoid haemorrhage. Neurol Res 9:188192, 1987 Smith RR, Clower BR, Cruse JM, et al: Constrictive structural elements in human cerebral arteries following aneurysmal subarachnoid haemorrhage. Neurol Res 9:188–192, 1987

    • Search Google Scholar
    • Export Citation
  • 34.

    Spetzler RF, & Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476483, 1986 Spetzler RF, Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986

    • Search Google Scholar
    • Export Citation
  • 35.

    Spiegelmann R, , Friedman WA, & Bova FJ: Limitations of angiographic target localization in planning radiosurgical treatment. Neurosurgery 30:619624, 1992 Spiegelmann R, Friedman WA, Bova FJ: Limitations of angiographic target localization in planning radiosurgical treatment. Neurosurgery 30:619–624, 1992

    • Search Google Scholar
    • Export Citation
  • 36.

    Steinberg GK, , Chang SD, & Levy RP, et al. : Surgical resection of large incompletely treated intracranial arteriovenous malformations following stereotactic radiosurgery. J Neurosurg 84:920928, 1996 Steinberg GK, Chang SD, Levy RP, et al: Surgical resection of large incompletely treated intracranial arteriovenous malformations following stereotactic radiosurgery. J Neurosurg 84:920–928, 1996

    • Search Google Scholar
    • Export Citation
  • 37.

    Szeifert GT, , Kemeny AA, & Timperley WR, et al. : The potential role of myofibroblasts in the obliteration of arteriovenous malformations after radiosurgery. Neurosurgery 40:6166, 1997 Szeifert GT, Kemeny AA, Timperley WR, et al: The potential role of myofibroblasts in the obliteration of arteriovenous malformations after radiosurgery. Neurosurgery 40:61–66, 1997

    • Search Google Scholar
    • Export Citation
  • 38.

    Yamamoto M, , Jimbo M, & Hara M, et al. : Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery 38:906914, 1996 Yamamoto M, Jimbo M, Hara M, et al: Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery 38:906–914, 1996

    • Search Google Scholar
    • Export Citation
  • 39.

    Yamamoto Y, , Coffey RJ, & Nichols DA et al. : Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate. J Neurosurg 83:832837, 1995 Yamamoto Y, Coffey RJ, Nichols DAet al: Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate. J Neurosurg 83:832–837, 1995

    • Search Google Scholar
    • Export Citation

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