Abstract
BACKGROUND AND PURPOSE-: The purpose of this study was to define the risk of rebleeding after stereotactic radiosurgery (SRS) for hemorrhagic arteriovenous malformations with or without associated intracranial aneurysms. METHODS-: Between 1987 and 2006, we performed Gamma Knife SRS on 996 patients with brain arteriovenous malformations; 407 patients had sustained an arteriovenous malformation hemorrhage. Sixty-four patients (16%) underwent prior embolization and 84 (21%) underwent prior surgical resection. The median target volume was 2.3 mL (range, 0.1-20.7 mL). The median margin dose was 20 Gy (range, 13.5-27 Gy). RESULTS-: The overall rate of total obliteration defined by angiography or MRI was 56%, 77%, 80%, and 82% at 3, 4, 5, and 10 years, respectively. Before obliteration, 33 patients (8%) sustained an additional hemorrhage after SRS. The overall annual hemorrhage rate until obliteration after SRS was 1.3%. The presence of a patent aneurysm was significantly associated with an increased rehemorrhage risk after SRS (annual hemorrhage rate, 6.4%) compared with patients with a clipped or embolized aneurysm (annual hemorrhage rate, 0.8%; P=0.033). CONCLUSIONS-: When an aneurysm is identified in patients with arteriovenous malformations selected for SRS, additional endovascular or surgical strategies should be considered to reduce the risk of bleeding during the latency interval.
| Original language | English |
|---|---|
| Pages (from-to) | 2586-2591 |
| Number of pages | 6 |
| Journal | Stroke |
| Volume | 43 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 2012 Oct 1 |
| Externally published | Yes |
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Keywords
- arteriovenous malformation
- complications
- Gamma knife
- hemorrhage
- stereotactic radiosurgery
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Clinical Neurology
- Advanced and Specialised Nursing
Cite this
Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations. / Kano, Hideyuki; Kondziolka, Douglas; Flickinger, John C.; Yang, Huai Che; Park, Kyung-Jae; Flannery, Thomas J.; Liu, Xiaomin; Niranjan, Ajay; Lunsford, L. Dade.
In: Stroke, Vol. 43, No. 10, 01.10.2012, p. 2586-2591.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations
AU - Kano, Hideyuki
AU - Kondziolka, Douglas
AU - Flickinger, John C.
AU - Yang, Huai Che
AU - Park, Kyung-Jae
AU - Flannery, Thomas J.
AU - Liu, Xiaomin
AU - Niranjan, Ajay
AU - Lunsford, L. Dade
PY - 2012/10/1
Y1 - 2012/10/1
N2 - BACKGROUND AND PURPOSE-: The purpose of this study was to define the risk of rebleeding after stereotactic radiosurgery (SRS) for hemorrhagic arteriovenous malformations with or without associated intracranial aneurysms. METHODS-: Between 1987 and 2006, we performed Gamma Knife SRS on 996 patients with brain arteriovenous malformations; 407 patients had sustained an arteriovenous malformation hemorrhage. Sixty-four patients (16%) underwent prior embolization and 84 (21%) underwent prior surgical resection. The median target volume was 2.3 mL (range, 0.1-20.7 mL). The median margin dose was 20 Gy (range, 13.5-27 Gy). RESULTS-: The overall rate of total obliteration defined by angiography or MRI was 56%, 77%, 80%, and 82% at 3, 4, 5, and 10 years, respectively. Before obliteration, 33 patients (8%) sustained an additional hemorrhage after SRS. The overall annual hemorrhage rate until obliteration after SRS was 1.3%. The presence of a patent aneurysm was significantly associated with an increased rehemorrhage risk after SRS (annual hemorrhage rate, 6.4%) compared with patients with a clipped or embolized aneurysm (annual hemorrhage rate, 0.8%; P=0.033). CONCLUSIONS-: When an aneurysm is identified in patients with arteriovenous malformations selected for SRS, additional endovascular or surgical strategies should be considered to reduce the risk of bleeding during the latency interval.
AB - BACKGROUND AND PURPOSE-: The purpose of this study was to define the risk of rebleeding after stereotactic radiosurgery (SRS) for hemorrhagic arteriovenous malformations with or without associated intracranial aneurysms. METHODS-: Between 1987 and 2006, we performed Gamma Knife SRS on 996 patients with brain arteriovenous malformations; 407 patients had sustained an arteriovenous malformation hemorrhage. Sixty-four patients (16%) underwent prior embolization and 84 (21%) underwent prior surgical resection. The median target volume was 2.3 mL (range, 0.1-20.7 mL). The median margin dose was 20 Gy (range, 13.5-27 Gy). RESULTS-: The overall rate of total obliteration defined by angiography or MRI was 56%, 77%, 80%, and 82% at 3, 4, 5, and 10 years, respectively. Before obliteration, 33 patients (8%) sustained an additional hemorrhage after SRS. The overall annual hemorrhage rate until obliteration after SRS was 1.3%. The presence of a patent aneurysm was significantly associated with an increased rehemorrhage risk after SRS (annual hemorrhage rate, 6.4%) compared with patients with a clipped or embolized aneurysm (annual hemorrhage rate, 0.8%; P=0.033). CONCLUSIONS-: When an aneurysm is identified in patients with arteriovenous malformations selected for SRS, additional endovascular or surgical strategies should be considered to reduce the risk of bleeding during the latency interval.
KW - arteriovenous malformation
KW - complications
KW - Gamma knife
KW - hemorrhage
KW - stereotactic radiosurgery
UR - http://www.scopus.com/inward/record.url?scp=84866742311&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866742311&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.112.664045
DO - 10.1161/STROKEAHA.112.664045
M3 - Article
C2 - 22879101
AN - SCOPUS:84866742311
VL - 43
SP - 2586
EP - 2591
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 10
ER -