Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 13;88(2):313-321.
doi: 10.1093/neuros/nyaa418.

Stereotactic Radiosurgery With Versus Without Embolization for Brain Arteriovenous Malformations

Ching-Jen Chen  1 , Dale Ding  2 , Cheng-Chia Lee  3   4 , Kathryn N Kearns  1 , I Jonathan Pomeraniec  1 , Christopher P Cifarelli  5 , David E Arsanious  5 , Roman Liscak  6 , Jaromir Hanuska  6 , Brian J Williams  2 , Mehran B Yusuf  7 , Shiao Y Woo  7 , Natasha Ironside  1 , Ronald E Warnick  8 , Daniel M Trifiletti  9 , David Mathieu  10 , Monica Mureb  11 , Carolina Benjamin  11 , Douglas Kondziolka  11 , Caleb E Feliciano  12 , Rafael Rodriguez-Mercado  12 , Kevin M Cockroft  13 , Scott Simon  13 , Heath B Mackley  14 , Samer Zammar  13 , Neel T Patel  13 , Varun Padmanaban  13 , Nathan Beatson  15 , Anissa Saylany  15 , John Lee  15 , Jason P Sheehan  1
Affiliations

Stereotactic Radiosurgery With Versus Without Embolization for Brain Arteriovenous Malformations

Ching-Jen Chen et al. Neurosurgery. .

Abstract

Background: Prior comparisons of brain arteriovenous malformations (AVMs) treated using stereotactic radiosurgery (SRS) with or without embolization were inherently flawed, due to differences in the pretreatment nidus volumes.

Objective: To compare the outcomes of embolization and SRS, vs SRS alone for AVMs using pre-embolization malformation features.

Methods: We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Patients were categorized into the embolization and SRS (E + SRS) or SRS alone (SRS-only) cohorts. The 2 cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was defined as AVM obliteration. Secondary outcomes were post-SRS hemorrhage, all-cause mortality, radiologic and symptomatic radiation-induced changes (RIC), and cyst formation.

Results: The matched cohorts each comprised 101 patients. Crude AVM obliteration rates were similar between the matched E + SRS vs SRS-only cohorts (48.5% vs 54.5%; odds ratio = 0.788, P = .399). Cumulative probabilities of obliteration at 3, 4, 5, and 6 yr were also similar between the E + SRS (33.0%, 46.4%, 56.2%, and 60.8%, respectively) and SRS-only (32.9%, 46.2%, 56.0%, and 60.6%, respectively) cohorts (subhazard ratio (SHR) = 1.005, P = .981). Cumulative probabilities of radiologic RIC at 3, 4, 5, and 6 yr were lower in the E + SRS (25.0%, 25.7%, 26.7%, and 26.7%, respectively) vs SRS-only (45.3%, 46.2%, 47.8%, and 47.8%, respectively) cohort (SHR = 0.478, P = .004). Symptomatic and asymptomatic embolization-related complication rates were 8.3% and 18.6%, respectively. Rates of post-SRS hemorrhage, all-cause mortality, symptomatic RIC, and cyst formation were similar between the matched cohorts.

Conclusion: This study refutes the prevalent notion that AVM embolization negatively affects the likelihood of obliteration after SRS.

Keywords: Arteriovenous malformation; Embolization; Endovascular; Stereotactic radiosurgery; Stroke.

PubMed Disclaimer

LinkOut - more resources