Does the Diffuseness of the Nidus Affect the Outcome of Stereotactic Radiosurgery in Patients with Unruptured Cerebral Arteriovenous Malformationsϵ

Huai Che Yang, Syu Jyun Peng, Cheng Chia Lee, Hsiu Mei Wu, Yu Wei Chen, Chung Jung Lin, Cheng Ying Shiau, Wan Yuo Guo, David Hung Chi Pan, Kang Du Liu, Wen Yuh Chung, Yung Yang Lin

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We proposed an algorithm to automate the components within the identification of components within the nidus of cerebral arteriovenous malformations (AVMs) which may be used to analyze the relationship between its diffuseness and treatment outcomes following stereotactic radiosurgery (SRS). Objectives: to determine the impact of the diffuseness of the AVM nidus on SRS outcomes. Methods: This study conducted regular follow-ups of 209 patients with unruptured AVMs who underwent SRS. The diffuseness of the AVM nidus was estimated by quantifying the proportions of vascular nidal component, brain parenchyma, and cerebrospinal fluid in T2-weighted MRIs. We used Cox regression analysis to characterize the association between nidal diffuseness and treatment outcomes in terms of obliteration rate and radiation-induced change (RICs) rate following SRS. Results: The median AVM volume was 20.7 cm3. The median duration of imaging follow-up was 51 months after SRS. The overall AVM obliteration rate was 68.4%. RICs were identified in 156 of the 209 patients (74.6%). The median proportions of the nidus of AVM and brain parenchyma components within the prescription isodose range were 30.2 and 52.2%, respectively. Cox regression multivariate analysis revealed that the only factor associated with AVM obliteration rate after SRS was AVM volume. However, a larger AVM volume (>20 mL) and a larger proportion of brain parenchyma (>50%) within the prescription isodose range were both correlated with a higher RIC rate following SRS. Conclusions: The diffuseness of the nidus indeed appears to affect the RIC rate following SRS in patients with unruptured AVMs.

Original languageEnglish
Pages (from-to)113-122
Number of pages10
JournalStereotactic and Functional Neurosurgery
Volume99
Issue number2
DOIs
Publication statusPublished - Apr 2021

Keywords

  • Cerebral arteriovenous malformation
  • Complication
  • Gamma knife
  • Hemorrhage
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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