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A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery
Ist Teil von
International journal of radiation oncology, biology, physics, 1999-04, Vol.44 (1), p.67-74
Ort / Verlag
New York, NY: Elsevier Inc
Erscheinungsjahr
1999
Link zum Volltext
Quelle
Elsevier Journal Backfiles on ScienceDirect (DFG Nationallizenzen)
Beschreibungen/Notizen
Purpose: To better understand radiation complications of arteriovenous malformation (AVM) radiosurgery and factors affecting their resolution.
Methods and Materials: AVM patients (102/1255) who developed neurological sequelae after radiosurgery were studied. The median AVM marginal dose (D
min) 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).
Results: 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%).
Conclusion: 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.