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Long-Term Outcome of Time-Staged Gamma Knife Radiosurgery for Large Arteriovenous Malformations.
Myeong, Ho Sung; Jeong, Sang Soon; Kim, Jung Hoon; Lee, Jae Meen; Park, Kwang Hyon; Park, Kawngwoo; Park, Hyun Joo; Park, Hye Ran; Yoon, Byung Woo; Hahn, Seokyung; Lee, Eun Jung; Kim, Jin Wook; Chung, Hyun Tai; Kim, Dong Gyu; Paek, Sun Ha.
Afiliación
  • Myeong HS; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Jeong SS; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Kim JH; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Lee JM; Department of Neurosurgery, Pusan National University Hospital, Busan, Korea.
  • Park KH; Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea.
  • Park K; Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.
  • Park HJ; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Park HR; Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
  • Yoon BW; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
  • Hahn S; Department of Human Systems Medicine, Medical Statistics Laboratory, Seoul National University College of Medicine, Seoul, Korea.
  • Lee EJ; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Kim JW; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Chung HT; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Kim DG; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • Paek SH; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci ; 39(29): e217, 2024 Jul 29.
Article en En | MEDLINE | ID: mdl-39079685
ABSTRACT

BACKGROUND:

Treatment for large (> 10 mL) arteriovenous malformations (AVMs) remains highly challenging. This study evaluated long-term effect of time-staged gamma knife radiosurgery (GKS) for large AVMs.

METHODS:

For patients with large AVMs treated by time-staged GKS over 10 years, time-staged GKS was repeated every three years targeting the entire nidus if total obliteration was not achieved. Obliteration rate and post-GKS complications were assessed based on 10 mL volume interval of AVMs. Prognostic factors for these outcomes were evaluated using Cox regression analysis.

RESULTS:

Ninety-six patients were analyzed. For AVMs in the 10-20 mL subgroup, a dose ≥ 13.5Gy yielded higher obliteration rate in the first GKS. In the 20-30 mL subgroup, a second GKS significantly boosted obliteration. AVMs > 30 mL did not achieve any obliteration with the first GKS. Among 35 (36.4%) cases lost to follow-up, 7 (7.2%) were lost due to GKS complications. Kaplan-Meier analysis showed that each subgroup needed different time for achieving 50% favorable obliteration outcome rate 3.5, 6.5, and 8.2 years for 10-20 mL, 20-30 mL, and > 30 mL subgroup, respectively. Total obliteration rate calculated by intention-to-treat

method:

73%, 51.7%, 35.7%, respectively, 61.5% overall. Post-GKS hemorrhage and chronic encapsulated expanding hematoma (CEEH) occurred in 13.5% and 8.3% of cases, respectively. Two patients died. Dose and volume were significant prognostic factors for obliteration. Initial AVM volume was a significant prognostic factor of post-GKS hemorrhage and CEEH.

CONCLUSION:

Time-staged GKS for large AVMs less than 30 mL has highly favorable long-term outcome and a tolerable complication rate.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Radiocirugia / Estimación de Kaplan-Meier Límite: Adolescent / Adult / Aged / Child / Female / Humans / Male / Middle aged Idioma: En Revista: J Korean Med Sci Asunto de la revista: MEDICINA Año: 2024 Tipo del documento: Article Pais de publicación:
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Radiocirugia / Estimación de Kaplan-Meier Límite: Adolescent / Adult / Aged / Child / Female / Humans / Male / Middle aged Idioma: En Revista: J Korean Med Sci Asunto de la revista: MEDICINA Año: 2024 Tipo del documento: Article Pais de publicación: