Article Figures & Data
Figures
- FIG 1.
A, Kaplan-Meier curve for the obliteration of AVMs after the first GKRS. Cumulative complete obliteration of AVMs after the first GKRS with or without the development of RICs. RIC development was not significantly associated with AVM obliteration (P = .12). The dotted line represents AVMs without RICs (−), and the solid line, those with RICs (+). B, Cumulative obliteration of AVMs after repeat GKRS with or without the development of RICs after the first GKRS. The development of RICs was significantly associated with AVM obliteration (P = .03).
- FIG 2.
Radiation-induced changes and the volume change ratio of residual AVMs after the first GKRS. The association between RIC development and AVM volume reduction after the first GKRS. Among patients who underwent repeat GKRS, the median rate of AVM volume change after the first treatment was 32.2% (range, 6.9%–205%) for patients without RICs (−) and 10.2% (range, 3.18%–231%) for those with RICs (+), respectively (P = .01).
Tables
Initial GKRS Repeat GKRS P Value No. 150 25 Male (No.) (%) 85 (56.7) 10 (40) .12 Median age (range) (yr) 37 (9–79) 39 (14–69) .55 Median follow-up after each GKRS (range) (mo) 102 (15–221) 79 (22–209) .01 Median interval between the initial and repeat GKRS (range) (mo) – 58 (36–94) – Note:—The dash (–) indicates not applicable.
Total No. (n = 150) Obliteration (n = 104) (69.3%) Incomplete Obliteration (n = 46) (30.7%) P Value Rupture (No.) (%) 53 (35.3) 33 (31.7) 20 (43.5) .13 Spetzler-Martin grade (No.) (%) <.001 I/II 80 (53.3) 68 (65.4) 12 (26.1) III/IV/V 70 (46.7) 36 (34.6) 34 (73.9) Median AVM score (range) 1.19 (0.289–3.92) 1.16 (0.289–2.23) 1.28 (0.302–3.92) .05 Deep drainage (No.) (%) 86 (57.3) 54 (52.0) 32 (69.6) .04 Location (No.) (%) .016 Lobar 112 (74.7) 80 (76.9) 32 (69.6) Thalamus/basal ganglia/brainstem 22 (14.7) 10 (9.6) 12 (26.1) Cerebellum 16 (10.7) 14 (13.5) 2 (4.3) Eloquent cortex of adjacent brain (No.) (%) 82 (54.6) 50 (48.1) 32 (69.6) .02 Prior embolization (No.) (%) 15 (10.0) 10 (9.6) 5 (10.9) .77 Median AVM volume (range) (mL) 3.51 (0.026–31.3) 1.51 (0.026–13.6) 3.6 (0.027–31.3) .007 Median margin dose (range) (Gy) 20 (12–23) 20 (12–23) 18 (12–23) <.001 Total No. (n = 25) Obliteration (n = 16) (64%) Incomplete Obliteration (n = 9) (36%) P Value Rupture (No.) (%) 18 (72) 11 (69) 7 (78) 1.0 Spetzler-Martin grade (No.) (%) .62 I/II 5 (20) 4 (25) 1 (11) III/IV/V 20 (80) 12 (75) 8 (89) Median AVM score (range) 1.17 (0.320–2.20) 1.25 (0.675–2.20) 0.86 (0.320–1.95) .12 Deep drainage (No.) (%) 17 (72) 10 (63) 7 (78) .66 Location (No.) (%) .85 Lobar 13 (52) 9 (57) 4 (44) Thalamus/basal ganglia/brainstem 10 (40) 6 (38) 4 (33) Cerebellum 2 (12) 1 (6.3) 1 (11) Eloquent cortex of adjacent brain (No.) (%) 17 (68) 11 (69) 6 (67) 1.0 Prior embolization (No.) (%) 6 (25) 4 (25) 2 (22) 1.0 Median AVM volume at initial GKRS (range) (mL) 3.70 (0.03–31.3) 4.90 (0.06–31.3) 3.5 (0.42–12.3) .80 Median AVM volume at repeat GKRS (range) (mL) 0.77 (0.048–9.2) 0.59 (0.054–9.2) 0.77 (0.048–4.1) .93 Median margin dose (range) (Gy) 18 (14–20) 20 (14–20) 18 (16–20) .36 >50% Reduction in volume after initial GKRS (No.) (%) 19 (76) 12 (75) 7 (77.8) 1.0 - Table 4:
The relationship between the development of RICs and AVM obliteration after each GKRS
Obliteration Incomplete Obliteration P Value Initial GKRS (No.) 104 46 RICs (No.) (%) 34 (32.7) 16 (34.8) .85 Repeat GKRS (No.) 16 9 Radiologic RICs after initial GKRS (No.) (%) 9 (56.3) 0 (0) .007 Radiologic RICs after repeat GKRS(No.) (%) 3 (18.8) 2 (22.2) 1.0 - Table 5:
The development of RICs and cyst formation after each GKRS in patients with AVMs of the brain
Initial GKRS (n = 150) Repeat GKRS (n = 25) P Value Radiologic RICs (No.) (%) 48 (32) 5 (20) .35 Symptomatic RICs (No.) (% of radiologic RICs) 8 (17) 1 (20) 1.0 Cyst formation (No.) (%) 2 (1.3) 0 (0.0) .56
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