Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations

Hideyuki Kano, Douglas Kondziolka, John C. Flickinger, Huai Che Yang, Kyung-Jae Park, Thomas J. Flannery, Xiaomin Liu, Ajay Niranjan, L. Dade Lunsford

Research output: Contribution to journalArticle

42 Citations (Scopus)

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 languageEnglish
Pages (from-to)2586-2591
Number of pages6
JournalStroke
Volume43
Issue number10
DOIs
Publication statusPublished - 2012 Oct 1
Externally publishedYes

Fingerprint

Radiosurgery
Arteriovenous Malformations
Aneurysm
Hemorrhage
Magnetic Resonance Angiography
Intracranial Aneurysm
Brain

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

Kano, H., Kondziolka, D., Flickinger, J. C., Yang, H. C., Park, K-J., Flannery, T. J., ... Lunsford, L. D. (2012). Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations. Stroke, 43(10), 2586-2591. https://doi.org/10.1161/STROKEAHA.112.664045

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 journalArticle

Kano, H, Kondziolka, D, Flickinger, JC, Yang, HC, Park, K-J, Flannery, TJ, Liu, X, Niranjan, A & Lunsford, LD 2012, 'Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations', Stroke, vol. 43, no. 10, pp. 2586-2591. https://doi.org/10.1161/STROKEAHA.112.664045
Kano, Hideyuki ; Kondziolka, Douglas ; Flickinger, John C. ; Yang, Huai Che ; Park, Kyung-Jae ; Flannery, Thomas J. ; Liu, Xiaomin ; Niranjan, Ajay ; Lunsford, L. Dade. / Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations. In: Stroke. 2012 ; Vol. 43, No. 10. pp. 2586-2591.
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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.",
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AU - Yang, Huai Che

AU - Park, Kyung-Jae

AU - Flannery, Thomas J.

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AU - Lunsford, L. Dade

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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.

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