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Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain

  • Diagnostic Neuroradiology
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Abstract

Introduction

Post-radiation injury of patients with brain arteriovenous malformations (AVM) include blood–brain barrier breakdown (BBBB), edema, and necrosis. Prevalence, clinical relevance, and response to treatment are poorly known. We present a series of consecutive brain AVM treated with stereotactic radiosurgery describing the appearance of radiation injury and clinical complications.

Methods

Consecutive patients with annual clinical and radiological follow-up (median length 63 months). Edema and BBBB were classified in four groups (minimal, perilesional, moderate, or severe), and noted together with necrosis. Clinical symptoms of interest were intracranial hypertension, new neurological deficits, new seizures, and brain hemorrhages.

Results

One hundred two cases, median age 34 years, 52 % male. Median irradiated volume 3.8 cc, dose to the margin of the nidus 18.5 Gy. Nineteen patients underwent a second radiosurgery. Only 42.2 % patients remained free from radiation injury. Edema was found in 43.1 %, blood–brain barrier breakdown in 20.6 %, necrosis in 6.9 %. Major injury (moderate or severe edema, moderate or severe BBBB, or necrosis) was found in 20 of 102 patients (19.6 %). AVM diameter >3 cm and second radiosurgery were independent predictors. Time to the worst imaging was 60 months. Patients with major radiation injury had a hazard ratio for appearance of focal deficits of 7.042 (p = 0.04), of intracranial hypertension 2.857 (p = 0.025), hemorrhage into occluded nidus 9.009 (p = 0.079), appearance of new seizures not significant.

Conclusions

Major radiation injury is frequent and increases the risk of neurological complications. Its late appearance implies that current follow-up protocols need to be extended in time.

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Acknowledgments

The authors would like to acknowledge the contribution of Dr. Larrea from the Virgen del Consuelo Hospital (Valencia, Spain), who performed the radiosurgeries.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, Hospital Universitario la Fe, Valencia, Spain

    Vera Parkhutik, Aida Lago, Juan Francisco Vazquez & Jose Ignacio Tembl

  2. Department of Neuroradiology, Hospital Universitario la Fe, Valencia, Spain

    Fernando Aparici, Lourdes Guillen, Esperanza Mainar & Victor Vazquez

  3. PhD Program of the Department of Medicine, Universidad Autonoma de Barcelona, Barcelona, Spain

    Vera Parkhutik

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  1. Vera Parkhutik
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  2. Aida Lago
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  5. Jose Ignacio Tembl
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  6. Lourdes Guillen
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  7. Esperanza Mainar
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  8. Victor Vazquez
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Correspondence to Vera Parkhutik.

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Parkhutik, V., Lago, A., Aparici, F. et al. Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain. Neuroradiology 55, 405–412 (2013). https://doi.org/10.1007/s00234-012-1115-8

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  • DOI: https://doi.org/10.1007/s00234-012-1115-8

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