gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Treatment of cerebral arteriovenous malformations with radiosurgery (RS) or hypofractionated stereotactic radiotherapy (hfSRT) in a consecutive and pooled LINAC series: 15 years of experience and observation

Meeting Abstract

  • Jan Boström - Abteilung für Radiochirurgie und Stereotaktische Radiotherapie, MediClin Robert Janker Klinik and MediClin MVZ Bonn, Bonn, Germany; Klinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Germany
  • Ruth Bruckermann - Abteilung für Radiochirurgie und Stereotaktische Radiotherapie, MediClin Robert Janker Klinik and MediClin MVZ Bonn, Bonn, Germany
  • Bogdan Pintea - Klinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Germany
  • Gunnar Surber - Abteilung für Radiochirurgie und Präzisionsbestrahlung, HELIOS Klinikum Erfurt, Erfurt, Germany
  • Klaus Hamm - Abteilung für Radiochirurgie und Präzisionsbestrahlung, HELIOS Klinikum Erfurt, Erfurt, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.12.01

doi: 10.3205/16dgnc057, urn:nbn:de:0183-16dgnc0577

Published: June 8, 2016

© 2016 Boström et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: To review outcomes after LINAC radiosurgery (RS) or hypofractionated stereotactic radiotherapy (hfSRT) of arteriovenous malformations (AVM) from a consecutive and pooled series of two Novalis® centers and to analyse influence of AVM size, Spetzler-Martin (SM) grade, pre-treatment, and hemorrhagic vs. non-hemorrhagic (incl. A Randomized Trial of Unruptured Brain AVM (ARUBA) eligible) presentation.

Method: Prospectively collected treatment and outcome data were supplemented by retrospectively collected follow-up (FU) data for 93.8% of all patients (pts). A total of 129 pts with AVMs had RS or hfSRT between 2000 and 2014 with the same LINAC system in two centers. Data analysis included initial presentation, SM grade, occlusion rates assessed by MR- and/or digital subtraction angiography, neurological and therapeutical complications, and pre-treatments. Statistical analysis was performed for pts’ demographic data and for factors potentially influencing outcome.

Results: Initial presentation was hemorrhage in 43.8% and seizures/neurological deficits in 46.2%. The series included 6 SM I (5%), 26 SM II (21.5%), 55 SM III (45.5%), 28 SM IV (23%) and 6 SM V cases (5%). Pre-embolization was used in 36 pts (29.8%), 8 pts had prior surgery (6.6%) and 6 pts were irradiated before (5%); 5 pts (4.2%) received multimodal pre-treatment. Mean FU was 43 months. The occlusion rate for the total series was 71.1% and 80.6% for the SM I/II and 67.4% for the SM >III subgroup. We found a high statistical significance regarding the SM grade. The occlusion rate was 55.6% for the large volume (>10 ccm) subgroup. There was no statistical difference between the occlusion rate of pts with or w/o pre-treatments if taken all modalities together (72.7% and 69.7%, respectively). There was only a trend of a belated occlusion of pre-embolized AVMs. The occlusion rate for hemorrhagic AVM was with 77.4% better than for non-hemorrhagic (66.2%) or ARUBA eligible AVM (64.8%) but without reaching statistical significance. Neurological deterioration was seen in 13.2% of the pts. There were 2 re-bleedings (1.7%), one of them w/o a new neurological deficit and total occlusion after re-RS. One patient with pre-existing epilepsy died a sudden unexpected death (mortality rate: 0.8%).

Conclusions: Overall RS and hfSRT are valuable therapy options esp. in symptomatic AVM pts with a low rate of morbidity and mortality and an acceptable overall complete occlusion rate of >70% and >80% for the small AVMs.