Citations 13
Brain arteriovenous malformations
Ding, Dale , Derdeyn, Colin P. , Southerland, Andrew M. , Lawton, Michael T. , Sheehan, Jason P. , Friedlander, Robert M, Southerland, Andrew M , Ding, Dale , Derdeyn, Colin P , Chen, Ching‐Jen , Lanzino, Giuseppe , Friedlander, Robert Max
Neurology | October 2, 2020 | Volume: 95 | Issue: 20 | Pages: 917-927
Stereotactic Radiosurgery With Versus Without Embolization for Brain Arteriovenous Malformations
Ding, Dale , Lee, Cheng‐Chia , Kearns, Kathryn N. , Pomeraniec, I. Jonathan , Cifarelli, Christopher P. , Arsanious, David, Liščák, Roman , Hanuška, Jaromír, Woo, Shiao Y. , Ironside, Natasha , Warnick, Ronald E. , Mathieu, David , Mureb, Monica , Benjamin, Carolina , Feliciano, Caleb , Rodríguez‐Mercado, Rafael, Cockroft, Kevin M. , Simon, Scott D. , Mackley, Heath B., Zammar, Samer G. , Patel, Neel, Padmanaban, Varun , Beatson, Nathan, Saylany, Anissa , Lee, John, Sheehan, Jason P. , May, Jaromír , Ding, Dale , Mathieu, David , Chen, Ching‐Jen , Williams, Brian J. , Yusuf, Mehran Behruj , Trifiletti, Daniel M. , Kondziolka, Douglas , Lee, John
Neurosurgery | August 23, 2020 | Volume: 88 | Issue: 2 | Pages: 313-321
Abstract BACKGROUND Prior comparisons of brain arteriovenous malformations (AVMs) treated using stereotactic radiosurgery (SRS) with or without embolization were inherently flawed, due to differences in the pretreatment nidus volumes. OBJECTIVE To compare the outcomes of embolization and SRS, vs SRS alone for AVMs using pre-embolization malformation features. METHODS We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Patients were categorized into the embolization and SRS (E + SRS) or SRS alone (SRS-only) cohorts. The 2 cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was defined as AVM obliteration. Secondary outcomes were post-SRS hemorrhage, all-cause mortality, radiologic and symptomatic radiation-induced changes (RIC), and cyst formation. RESULTS The matched cohorts each comprised 101 patients. Crude AVM obliteration rates were similar between the matched E + SRS vs SRS-only cohorts (48.5% vs 54.5%; odds ratio = 0.788, P = .399). Cumulative probabilities of obliteration at 3, 4, 5, and 6 yr were also similar between the E + SRS (33.0%, 46.4%, 56.2%, and 60.8%, respectively) and SRS-only (32.9%, 46.2%, 56.0%, and 60.6%, respectively) cohorts (subhazard ratio (SHR) = 1.005, P = .981). Cumulative probabilities of radiologic RIC at 3, 4, 5, and 6 yr were lower in the E + SRS (25.0%, 25.7%, 26.7%, and 26.7%, respectively) vs SRS-only (45.3%, 46.2%, 47.8%, and 47.8%, respectively) cohort (SHR = 0.478, P = .004). Symptomatic and asymptomatic embolization-related complication rates were 8.3% and 18.6%, respectively. Rates of post-SRS hemorrhage, all-cause mortality, symptomatic RIC, and cyst formation were similar between the matched cohorts. CONCLUSION This study refutes the prevalent notion that AVM embolization negatively affects the likelihood of obliteration after SRS.
Embolization of Brain Arteriovenous Malformations With Versus Without Onyx Before Stereotactic Radiosurgery
Chen, Ching‐Jen , Ding, Dale , Lee, Cheng‐Chia , Kearns, Kathryn N. , Pomeraniec, I. Jonathan , Cifarelli, Christopher P. , Arsanious, David, Liščák, Roman , Hanuška, Jaromír, Woo, Shiao Y. , Ironside, Natasha , Warnick, Ronald E. , Mathieu, David , Mureb, Monica , Benjamin, Carolina , Feliciano, Caleb , Rodríguez‐Mercado, Rafael, Cockroft, Kevin M. , Simon, Scott D. , Mackley, Heath B., Zammar, Samer G. , Patel, Neel, Padmanaban, Varun , Beatson, Nathan, Saylany, Anissa , Lee, John, Sheehan, Jason P. , May, Jaromír , Ding, Dale , Mathieu, David , Chen, Ching-Jen , Williams, Brian J. , Yusuf, Mehran Behruj , Trifiletti, Daniel M. , Kondziolka, Douglas , Lee, John
Neurosurgery | July 23, 2020 | Volume: 88 | Issue: 2 | Pages: 366-374
Abstract BACKGROUND Embolization of brain arteriovenous malformations (AVMs) using ethylene-vinyl alcohol copolymer (Onyx) embolization may influence the treatment effects of stereotactic radiosurgery (SRS) differently than other embolysates. OBJECTIVE To compare the outcomes of pre-SRS AVM embolization with vs without Onyx through a multicenter, retrospective matched cohort study. METHODS We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Embolized AVMs treated with SRS were selected and categorized based on embolysate usage into Onyx embolization (OE + SRS) or non-Onyx embolization (NOE + SRS) cohorts. The 2 cohorts were matched in a 1:1 ratio using de novo AVM features for comparative analysis of outcomes. RESULTS The matched cohorts each comprised 45 patients. Crude AVM obliteration rates were similar between the matched OE + SRS vs NOE + SRS cohorts (47% vs 51%; odds ratio [OR] = 0.837, P = .673). Cumulative probabilities of obliteration were also similar between the OE + SRS vs NOE + SRS cohorts (subhazard ratio = 0.992, P = .980). Rates of post-SRS hemorrhage, all-cause mortality, radiation-induced changes, cyst formation, and embolization-associated complications were similar between the matched cohorts. Sensitivity analysis for AVMs in the OE + SRS cohort embolized with Onyx alone revealed a higher rate of asymptomatic embolization-associated complications in this subgroup compared to the NOE + SRS cohort (36% vs 15%; OR = 3.297, P = .034), but the symptomatic complication rates were similar. CONCLUSION Nidal embolization using Onyx does not appear to differentially impact the outcomes of AVM SRS compared with non-Onyx embolysates. The embolic agent selected for pre-SRS AVM embolization should reflect both the experience of the neurointerventionalist and target of endovascular intervention.