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Prognostic Factors of Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformation : The Results from 218 Consecutive Patients

Authors
 Deok Young Kim  ;  Keun Young Park  ;  Jae Whan Lee  ;  Seung Kon Huh  ;  Hyun Ho Jung  ;  Jong Hee Chang  ;  Jin Woo Chang  ;  Yong Gou Park  ;  Won Seok Chang 
Citation
 Journal of the Korean Society of Stereotactic and Functional Neurosurgery (대한정위기능신경외과학회지), Vol.11 : 106-111, 2015 
Journal Title
 Journal of the Korean Society of Stereotactic and Functional Neurosurgery (대한정위기능신경외과학회지) 
ISSN
 1738-6217 
Issue Date
2015
Keywords
Arteriovenous malformation (AVM) ; Gamma knife radiosurgery (GKRS) ; Obliteration rate ; Prognostic factors
Abstract
Objective: We retrospectively evaluated our experience of the management and long-term outcomes of gamma knife radiosurgery (GKRS) on arteriovenous malformation (AVM) as a primary treatment as well as adjunct therapy. GKRS is widely used in many centers worldwide for the management of AVM. However, the long-term results of GKRS are not well known. In the present study, we retrospectively evaluated our experience of focusing on prognostic factors in the management and long-term outcomes of GKRS on AVM. Materials and Methods: We performed a retrospective review of 218 patients. They were treated with GKRS in our institute from 2007 to 2013. The group included first-time GKRS for cerebral AVM, previous surgical resection, and embolization, excluding previously GKRS-treated patients. We analyzed the association between several factors (gender, age, marginal dose, hemorrhage, marginal dose, nidus volume) and the obliteration rate, which was the cumulative obliteration rate regardless of additional treatment, including repeat GKRS. Results: The univariate analysis of our study identified that a high radiation dose [margin dose >16.0Gy (50%), p=0.017] rather than a low radiation dose [margin dose ≤16.0Gy (50%)] and small AVM volume (≤15.0mL, p=0.003) rather than large AVM volume (>15.0mL) were positive predictors of AVM nidus obliteration. Our study showed that young age (≤18 years) had a better obliteration rate compared with others (>18 years) in AVM after GKRS (p=0.053). Our findings did not show that gender (p= 0.427) or hemorrhage (p=0.191) had significant effects on nidus obliteration. Comparison of our results with prior studies showed that AVM volume and margin radiation dose had a significant role in the obliteration rate in common. Conclusion: We suggest that AVM with a small volume can be considered good indications for GKRS, and a higher marginal dose [margin dose >16.0Gy (50%)] can be an effective factor for higher obliteration with the carefulness of post-radiosurgical complications. Finally, we can expect favorable GKRS results for appropriately selected AVMs in the young population.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Deok Young(김덕영)
Park, Keun Young(박근영)
Park, Yong Gou(박용구)
Lee, Jae Whan(이재환)
Chang, Won Seok(장원석) ORCID logo https://orcid.org/0000-0003-3145-4016
Chang, Jong Hee(장종희)
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
Jung, Hyun Ho(정현호)
Huh, Seung Kon(허승곤)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/156870
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