Long-Term Outcome of Time-Staged Gamma Knife Radiosurgery for Large Arteriovenous Malformations
10.3346/jkms.2024.39.e217
- Author:
Ho Sung MYEONG
1
;
Sang Soon JEONG
;
Jung Hoon KIM
;
Jae Meen LEE
;
Kwang Hyon PARK
;
Kawngwoo PARK
;
Hyun Joo PARK
;
Hye Ran PARK
;
Byung Woo YOON
;
Seokyung HAHN
;
Eun Jung LEE
;
Jin Wook KIM
;
Hyun Tai CHUNG
;
Dong Gyu KIM
;
Sun Ha PAEK
Author Information
1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Publication Type:Original Article
- From:Journal of Korean Medical Science
2024;39(29):e217-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Treatment for large (> 10 mL) arteriovenous malformations (AVMs) remains highly challenging. This study evaluated long-term effect of time-staged gamma knife radiosurgery (GKS) for large AVMs. Methods: For patients with large AVMs treated by time-staged GKS over 10 years, timestaged GKS was repeated every three years targeting the entire nidus if total obliteration was not achieved. Obliteration rate and post-GKS complications were assessed based on 10 mL volume interval of AVMs. Prognostic factors for these outcomes were evaluated using Cox regression analysis.
Results:Ninety-six patients were analyzed. For AVMs in the 10–20 mL subgroup, a dose ≥ 13.5Gy yielded higher obliteration rate in the first GKS. In the 20–30 mL subgroup, a second GKS significantly boosted obliteration. AVMs > 30 mL did not achieve any obliteration with the first GKS. Among 35 (36.4%) cases lost to follow-up, 7 (7.2%) were lost due to GKS complications. Kaplan-Meier analysis showed that each subgroup needed different time for achieving 50% favorable obliteration outcome rate: 3.5, 6.5, and 8.2 years for 10–20 mL, 20–30 mL, and > 30 mL subgroup, respectively. Total obliteration rate calculated by intention-to-treat method: 73%, 51.7%, 35.7%, respectively, 61.5% overall. Post-GKS hemorrhage and chronic encapsulated expanding hematoma (CEEH) occurred in 13.5% and 8.3% of cases, respectively.Two patients died. Dose and volume were significant prognostic factors for obliteration. Initial AVM volume was a significant prognostic factor of post-GKS hemorrhage and CEEH.
Conclusion:Time-staged GKS for large AVMs less than 30 mL has highly favorable long-term outcome and a tolerable complication rate.
