Elena Zapata-Arriaza, MD
Ding D, Chen C-J, Starke RM, Kano H, Lee JYK, Mathieu D, et al. Risk of Brain Arteriovenous Malformation Hemorrhage Before and After Stereotactic Radiosurgery: A Multicenter Study. Stroke. 2019;50:1384–1391.
Stereotactic radiosurgery (SRS) has emerged as an alternative to neurosurgery or endovascular treatment for selected brain arteriovenous malformations (bAVM) management. Localization, size or perioperative risk are some of the selection criteria for SRS employment. Hemorrhagic risk of bAVM after SRS is based on single center studies. This study aims to obtain scientific evidence about bAVM hemorrhage rates before and after SRS and identify predictors of pre-post SRS AVM hemorrhage.
Patients with AVM treated with SRS in a single session from 1987 to 2014 were collected for the International Radiosurgery Research Foundation, formed by 8 institutions. For each AVM, Spetzler-Martin(SM) grade, virginia Radiosurgery AVM scale and modified radiosurgery-based AVM score were collected. In terms of SRS variables, margin dose, maximum dose and number of isocenters were analyzed. Radiological follow-up (with magnetic resonance image with/without contrast and computed tomography as alternative) was performed every 6 months for the first 2 years after SRS, and yearly thereafter. If the patient developed new or symptoms worsening, additional neuroimagen was performed.