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The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery

The brainstem arteriovenous malformations (BS-AVMs) have a high morbidity and mortality and stereotactic radiosurgery (SRS) has been widely used to treat BS-AVMs. However, no consensus is reached in the explicit predictors of obliteration for BS-AVMs after SRS. To identify the predictors of clinical...

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Autores principales: Ai, Xiaolin, Xu, Jianguo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183693/
https://www.ncbi.nlm.nih.gov/pubmed/34087891
http://dx.doi.org/10.1097/MD.0000000000026203
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author Ai, Xiaolin
Xu, Jianguo
author_facet Ai, Xiaolin
Xu, Jianguo
author_sort Ai, Xiaolin
collection PubMed
description The brainstem arteriovenous malformations (BS-AVMs) have a high morbidity and mortality and stereotactic radiosurgery (SRS) has been widely used to treat BS-AVMs. However, no consensus is reached in the explicit predictors of obliteration for BS-AVMs after SRS. To identify the predictors of clinical outcomes for BS-AVMs treated by SRS, we performed a retrospective observational study of BS-AVMs patients treated by SRS at our institution from 2006 to 2016. The primary outcomes were obliteration of nidus and favorable outcomes (AVM nidus obliteration with mRS score ≤2). For getting the outcomes more accurate, we also pooled the results of previous studies as well as our study by meta-analysis. A total of 26 patients diagnosed with BS-AVMs, with mean volume of 2.6 ml, were treated with SRS. Hemorrhage presentation accounted for 69% of these patients. Overall obliteration rate was 42% with mean follow-up of more than five years and two patients (8%) had a post-SRS hemorrhage. Favorable outcomes were observed in 8 patients (31%). Higher margin dose (>15Gy) was associated with higher obliteration (P = .042) and small volume of nidus was associated with favorable outcomes (P = .036). After pooling the results of 7 studies and present study, non-prior embolization (P = .049) and higher margin dose (P = .04) were associated with higher obliteration rate, in addition, the lower Virginia Radiosurgery AVM Scale (VRAS) was associated with favorable outcomes (P = .02) of BS-AVMs after SRS. In the BS-AVMs patients treated by SRS, higher margin dose (19–24Gy) and non-prior embolization were the independent predictors of higher obliteration rate. In addition, smaller volume of nidus and lower VRAS were the potential predictors of long-term favorable outcomes for these patients.
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spelling pubmed-81836932021-06-07 The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery Ai, Xiaolin Xu, Jianguo Medicine (Baltimore) 5300 The brainstem arteriovenous malformations (BS-AVMs) have a high morbidity and mortality and stereotactic radiosurgery (SRS) has been widely used to treat BS-AVMs. However, no consensus is reached in the explicit predictors of obliteration for BS-AVMs after SRS. To identify the predictors of clinical outcomes for BS-AVMs treated by SRS, we performed a retrospective observational study of BS-AVMs patients treated by SRS at our institution from 2006 to 2016. The primary outcomes were obliteration of nidus and favorable outcomes (AVM nidus obliteration with mRS score ≤2). For getting the outcomes more accurate, we also pooled the results of previous studies as well as our study by meta-analysis. A total of 26 patients diagnosed with BS-AVMs, with mean volume of 2.6 ml, were treated with SRS. Hemorrhage presentation accounted for 69% of these patients. Overall obliteration rate was 42% with mean follow-up of more than five years and two patients (8%) had a post-SRS hemorrhage. Favorable outcomes were observed in 8 patients (31%). Higher margin dose (>15Gy) was associated with higher obliteration (P = .042) and small volume of nidus was associated with favorable outcomes (P = .036). After pooling the results of 7 studies and present study, non-prior embolization (P = .049) and higher margin dose (P = .04) were associated with higher obliteration rate, in addition, the lower Virginia Radiosurgery AVM Scale (VRAS) was associated with favorable outcomes (P = .02) of BS-AVMs after SRS. In the BS-AVMs patients treated by SRS, higher margin dose (19–24Gy) and non-prior embolization were the independent predictors of higher obliteration rate. In addition, smaller volume of nidus and lower VRAS were the potential predictors of long-term favorable outcomes for these patients. Lippincott Williams & Wilkins 2021-06-04 /pmc/articles/PMC8183693/ /pubmed/34087891 http://dx.doi.org/10.1097/MD.0000000000026203 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle 5300
Ai, Xiaolin
Xu, Jianguo
The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
title The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
title_full The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
title_fullStr The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
title_full_unstemmed The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
title_short The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
title_sort predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183693/
https://www.ncbi.nlm.nih.gov/pubmed/34087891
http://dx.doi.org/10.1097/MD.0000000000026203
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