Authors: Vera Parkhutik Aida Lago Fernando Aparici Juan Francisco Vazquez Jose Ignacio Tembl Lourdes Guillen Esperanza Mainar Victor Vazquez
Publish Date: 2012/11/27
Volume: 55, Issue: 4, Pages: 405-412
Abstract
Postradiation 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 complicationsConsecutive patients with annual clinical and radiological followup 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 hemorrhagesOne hundred two cases median age 34 years 52 male Median irradiated volume 38 cc dose to the margin of the nidus 185 Gy Nineteen patients underwent a second radiosurgery Only 422 patients remained free from radiation injury Edema was found in 431 blood–brain barrier breakdown in 206 necrosis in 69 Major injury moderate or severe edema moderate or severe BBBB or necrosis was found in 20 of 102 patients 196 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 7042 p = 004 of intracranial hypertension 2857 p = 0025 hemorrhage into occluded nidus 9009 p = 0079 appearance of new seizures not significant
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