Volume-staged versus dose-staged radiosurgery outcomes for large intracranial arteriovenous malformations

Shayan Moosa, Ching Jen Chen, Dale Ding, Cheng Chia Lee, Srinivas Chivukula, Robert M. Starke, Chun Po Yen, Zhiyuan Xu, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

Object: The aim in this paper was to compare the outcomes of dose-staged and volume-staged stereotactic radiosurgery (SRS) in the treatment of large (> 10 cm3) arteriovenous malformations (AVMs). Methods: A systematic literature review was performed using PubMed. Studies written in the English language with at least 5 patients harboring large (> 10 cm3) AVMs treated with dose- or volume-staged SRS that reported posttreatment outcomes data were selected for review. Demographic information, radiosurgical treatment parameters, and post-SRS outcomes and complications were analyzed for each of these studies. Results: The mean complete obliteration rates for the dose- and volume-staged groups were 22.8% and 47.5%, respectively. Complete obliteration was demonstrated in 30 of 161 (18.6%) and 59 of 120 (49.2%) patients in the dose- and volume-staged groups, respectively. The mean rates of symptomatic radiation-induced changes were 13.5% and 13.6% in dose- and volume-staged groups, respectively. The mean rates of cumulative post-SRS latency period hemorrhage were 12.3% and 17.8% in the dose- and volume-staged groups, respectively. The mean rates of post-SRS mortality were 3.2% and 4.6% in dose- and volume-staged groups, respectively. Conclusions: Volume-staged SRS affords higher obliteration rates and similar complication rates compared with dose-staged SRS. Thus, volume-staged SRS may be a superior approach for large AVMs that are not amenable to single-session SRS. Staged radiosurgery should be considered as an efficacious component of multimodality AVM management.

Original languageEnglish (US)
Article numberArticle E18
JournalNeurosurgical focus
Volume37
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Arteriovenous malformation
  • Dose-staged
  • Review
  • Staging
  • Stereotactic radiosurgery
  • Volume-staged

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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