Gamma Knife Radiosurgery for Spetzler-Martin Grade III Brain Arteriovenous Malformations

Spetzler-Martin (SM) grade III arteriovenous malformations (AVMs) show angioarchitecture heterogeneity and lack a clearly defined treatment strategy. This study aims to evaluate outcomes after treatment of SM grade III AVMs with Gamma Knife radiosurgery (GKRS). A single-institution retrospective ana...

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Bibliographic Details
Published in:World neurosurgery 2023-07, Vol.175, p.e796-e803
Main Authors: Nguyen, Binh Thanh, Tran, Huy Minh, Huynh, Chuong Thanh, Nguyen, Tu Minh, Nguyen, Vu Tuong, Karras, Constantine L., Huynh-Le, Phuong
Format: Article
Language:English
Subjects:
Arteriovenous malformation
Brain
Follow-Up Studies
Gamma Knife
Humans
Intracranial Arteriovenous Malformations - radiotherapy
Intracranial Arteriovenous Malformations - surgery
Nervous System Malformations - surgery
Radiosurgery
Radiosurgery - methods
Retrospective Studies
Spetzler-Martin grade III
Treatment Outcome
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Summary:Spetzler-Martin (SM) grade III arteriovenous malformations (AVMs) show angioarchitecture heterogeneity and lack a clearly defined treatment strategy. This study aims to evaluate outcomes after treatment of SM grade III AVMs with Gamma Knife radiosurgery (GKRS). A single-institution retrospective analysis was conducted of 307 patients with SM grade III AVMs undergoing GKRS between October 2006 and December 2020 with follow-up times of at least 24 months. SM grade III AVMs were classified into 4 subtypes: IIIA (S1E1V1), IIIB (S2E0V1), subtype IIIC (S2E1V0), and IIID (S3E0V0). Over a median follow-up time of 50.3 months, complete AVM obliteration was achieved in 211 patients (68.7%). Complete obliteration rates in subtypes IIIA, IIIB, IIIC, and IIID were 80.8%, 55.4%, 53.4%, and 25.0%, respectively. Annual post-GKRS hemorrhage risk was 0.8%. Significant radiosurgery-induced imaging changes occurred in 7 patients (2.3%). Three variables were identified as predictors of obliteration in final forward stepwise regression models, including volume of AVM (B = –0.011; P < 0.001), age (B = –0.004; P = 0.024), and previous AVM hemorrhage (B = 0.187; P = 0.077). GKRS is a safe and effective treatment for SM grade III AVMs, particularly subtype IIIA (S1E1V1). AVM volume is the key predictor of post-GKRS obliteration.
ISSN:1878-8750
1878-8769
1878-8769
DOI:10.1016/j.wneu.2023.04.022