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Factors Determining the Clinical Complications of Radiosurgery for AVM

Published online by Cambridge University Press:  23 September 2014

Matylda Machnowska ,
Patamintita Taeshineetanakul ,
Sasikhan Geibprasert ,
Ravi Menezes ,
Ronit Agid ,
Karel G. Terbrugge ,
Yuri Andrade-Souza ,
Michael L. Schwartz  and
Timo Krings
Matylda Machnowska*
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Patamintita Taeshineetanakul
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Sasikhan Geibprasert
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Ravi Menezes
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Ronit Agid
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Karel G. Terbrugge
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Yuri Andrade-Souza
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
Michael L. Schwartz
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
Timo Krings
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
*
University of Toronto, Toronto Western Hospital, UHN, Division of Neuroradiology, 399 Bathurst St., 3MCL - 429, Toronto, Ontario, M5T 2S8, Canada. Email: mmachnowska@gmail.com.
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Abstract

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Purpose:

To identify the predictors of symptomatic post-radiation T2 signal change in patients with arteriovenous malformations (AVM) treated with radiosurgery.

Materials and Methods:

The charts of 211 consecutive patients with arteriovenous malformations treated with either gamma knife radisurgery or linear accelerator radiosurgery between 2000-2009 were retrospectively reviewed. 168 patients had a minimum of 12 months of clinical and radiologic follow-up following the procedure and complete dosage data. Pretreatment characteristics and dosimetric variables were analyzed to identify predictors of adverse radiation effects.

Results:

141 patients had no clinical symptomatic complications. 21 patients had global or focal neurological deficits attributed to symptomatic edema. Variables associated with development of symptomatic edema included a non-hemorrhagic symptomatic presentation compared to presentation with hemorrhage, p=0.001; OR (95%CI) = 6.26 (1.99, 19.69); the presence of venous rerouting compared to the lack of venous rerouting, p=0.031; OR (95% CI) = 3.25 (1.20, 8.80); radiosurgery with GKS compared to linear accelerator radiosurgery p = 0.012; OR (95% CI) = 4.58 (1.28, 16.32); and the presence of more than one draining vein compared to a single draining vein p = 0.032; OR (95% CI) = 2.82 (1.06, 7.50).

Conclusions:

We postulated that the higher maximal doses used with gamma knife radiosurgery may be responsible for the greater number of adverse radiation effects with this modality compared to linear accelerator radiosurgery. We found that AVMs with greater venous complexity and therefore instability resulted in more adverse treatment outcomes, suggesting that AVM angioarchitecture should be considered when making treatment decisions.

Résumé

RÉSUMÉObjectif:

Le but de l'étude était d'identifier les facteurs de prédiction de changement du signal T2 qui sont symptomatiques après l'irradiation chez des patients présentant une malformation artérioveineuse (MAV) traitée par radiochirurgie.

Méthode:

Les dossiers de 211 patients consécutifs atteints d'une MAV, qui ont été traités soit par radiochirurgie par scalpel gamma ou par radiochirurgie par accélérateur linéaire entre 2000 et 2009, ont été examinés rétrospectivement. Un suivi clinique et radiologique d'au moins 12 mois après le traitement était disponible ainsi que des données complètes sur la dose administrée chez 168 patients. Les caractéristiques avant le traitement et les variables dosimétriques ont été analysées pour identifier les facteurs de prédiction d'effets indésirables de l'irradiation.

Résultats:

Cent quarante et un patients n'ont pas présenté de complication symptomatique au point de vue clinique. Vingt et un patients ont présenté des déficits neurologiques globaux ou focaux attribués à un œdème symptomatique. L'une des variables associées à un œdème symptomatique était une symptomatologie non reliée à une hémorragie au moment de la consultation initiale par rapport une symptomatologie reliée à la présence d'une hémorragie (p = 0,001), RC = 6,26 ; IC à 95% : (1,99 à 19,69) ; la présence de déviation de la circulation veineuse par rapport à son absence (p = 0,031 ; RC = 3,25 ; IC à 95% : 1,20 à 8,80) ; la radiochirurgie par scalpel gamma par rapport à la radiochirurgie par accélérateur linéaire (p = 0,012 ; RC 95% = 4,58 ; IC à 95% : 1,28 à 16,32) ; et la présence de plus d'une veine de drainage par rapport à la présence d'une seule veine de drainage (p = 0,032 ; RC = 2,82 ; IC à 95% 1,06 à 7,50).

Conclusions:

Nous avons émis l'hypothèse que les doses maximales plus élevées utilisées lors de la radiochirurgie par scalpel gamma pourraient être responsables du plus grand nombre d'incidents thérapeutiques dus à l'irradiation par rapport à la radiochirurgie par accélérateur linéaire. Nous avons observé de moins bons résultats du traitement des MAV possédant une plus grande complexité veineuse et donc une plus grande instabilité, ce qui suggère que l'architecture des vaisseaux d'une MAV devrait être prise en considération lorsque du choix du traitement.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 6 , November 2013 , pp. 807 - 813
Copyright
Copyright © The Canadian Journal of Neurological 2013

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