Radiosurgery for unruptured brain arteriovenous ...
Document type :
Compte-rendu et recension critique d'ouvrage
PMID :
Title :
Radiosurgery for unruptured brain arteriovenous malformations in the pre-ARUBA era: long-term obliteration rate, risk of hemorrhage and functional outcomes.
Author(s) :
Peciu-Florianu, Iulia [Auteur]
Département de Neurochirurgie[Lille]
Leroy, Henri-Arthur [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Drumez, Elodie [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Dumot, Chloé [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Aboukaïs, Rabih [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Touzet, Gustavo [Auteur]
Département de Neurochirurgie[Lille]
Leclerc, Xavier [Auteur]
Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 [JPArc]
Blond, Serge [Auteur]
Département de neurologie [Lille]
Lejeune, Jean-Paul [Auteur]
Thérapies Assistées par Lasers et Immunothérapies pour l'Oncologie - U 1189 [OncoThAI]
Reyns, Nicolas [Auteur]
Thérapies Assistées par Lasers et Immunothérapies pour l'Oncologie - U 1189 [OncoThAI]
Département de Neurochirurgie[Lille]
Leroy, Henri-Arthur [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Drumez, Elodie [Auteur]

Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Dumot, Chloé [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Aboukaïs, Rabih [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Touzet, Gustavo [Auteur]
Département de Neurochirurgie[Lille]
Leclerc, Xavier [Auteur]

Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 [JPArc]
Blond, Serge [Auteur]
Département de neurologie [Lille]
Lejeune, Jean-Paul [Auteur]

Thérapies Assistées par Lasers et Immunothérapies pour l'Oncologie - U 1189 [OncoThAI]
Reyns, Nicolas [Auteur]

Thérapies Assistées par Lasers et Immunothérapies pour l'Oncologie - U 1189 [OncoThAI]
Journal title :
Scientific Reports
Pages :
21427
Publisher :
Nature Publishing Group
Publication date :
2020-12-17
ISSN :
2045-2322
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
The management of non-hemorrhagic arteriovenous malformations (AVMs) remains a subject of debate, even more since the ARUBA trial. Here, we report the obliteration rate, the risk of hemorrhage and the functional outcomes ...
Show more >The management of non-hemorrhagic arteriovenous malformations (AVMs) remains a subject of debate, even more since the ARUBA trial. Here, we report the obliteration rate, the risk of hemorrhage and the functional outcomes after Gamma Knife radiosurgery (GKRS) as first-line treatment for non-hemorrhagic AVMs treated before the ARUBA publication, in a reference university center with multimodal AVM treatments available. We retrospectively analyzed data from a continuous series of 172 patients harboring unruptured AVMs treated by GKRS as first-line treatment in our Lille University Hospital, France, between April 2004 and December 2013. The primary outcome was obliteration rate. Secondary outcomes were the hemorrhage rate, the modified Rankin Scale (mRS), morbidity and epilepsy control at last follow-up. The minimal follow-up period was of 3 years. Median age at presentation was 40 years (IQR 28; 51). Median follow-up was 8.8 years (IQR 6.8; 11.3). Median target volume was 1.9 cm3 (IQR 0.8–3.3 cm3), median Spetzler-Martin grade: 2 (IQR 1–2), median Pollock-Flickinger score: 1.07 (IQR 0.82–2.94), median Virginia score: 1 (IQR 1–2). Median treatment dose was 24 Gy at 50% isodose line. Twenty-three patients underwent a second GKRS after a median time of 58 months after first GKRS. The overall obliteration rate was of 76%, based primarily on cerebral angiography and/or rarely only upon MRI. Hemorrhage during the post-treatment follow-up was reported in 18 (10%) patients (annual risk of 1.1%). Transient post-GKRS morbidity was reported in 14 cases (8%) and persistent neurological deficit in 8 (4.6%) of patients. At last follow-up, 86% of patients had a mRS ≤ 1. Concerning patients with pretherapeutic epilepsy, 84.6% of them were seizure-free at last follow-up. GKRS as first-line therapeutic option for unruptured cerebral AVMs achieves high obliteration rates (76%) while maintaining a high-level patient’s autonomy. All hemorrhagic events occurred during the first 4 years after the initial GKRS. In cases with epilepsy, there was 84.6% seizure free at last follow-up. Permanent morbidity was reported in only 4.6%.Show less >
Show more >The management of non-hemorrhagic arteriovenous malformations (AVMs) remains a subject of debate, even more since the ARUBA trial. Here, we report the obliteration rate, the risk of hemorrhage and the functional outcomes after Gamma Knife radiosurgery (GKRS) as first-line treatment for non-hemorrhagic AVMs treated before the ARUBA publication, in a reference university center with multimodal AVM treatments available. We retrospectively analyzed data from a continuous series of 172 patients harboring unruptured AVMs treated by GKRS as first-line treatment in our Lille University Hospital, France, between April 2004 and December 2013. The primary outcome was obliteration rate. Secondary outcomes were the hemorrhage rate, the modified Rankin Scale (mRS), morbidity and epilepsy control at last follow-up. The minimal follow-up period was of 3 years. Median age at presentation was 40 years (IQR 28; 51). Median follow-up was 8.8 years (IQR 6.8; 11.3). Median target volume was 1.9 cm3 (IQR 0.8–3.3 cm3), median Spetzler-Martin grade: 2 (IQR 1–2), median Pollock-Flickinger score: 1.07 (IQR 0.82–2.94), median Virginia score: 1 (IQR 1–2). Median treatment dose was 24 Gy at 50% isodose line. Twenty-three patients underwent a second GKRS after a median time of 58 months after first GKRS. The overall obliteration rate was of 76%, based primarily on cerebral angiography and/or rarely only upon MRI. Hemorrhage during the post-treatment follow-up was reported in 18 (10%) patients (annual risk of 1.1%). Transient post-GKRS morbidity was reported in 14 cases (8%) and persistent neurological deficit in 8 (4.6%) of patients. At last follow-up, 86% of patients had a mRS ≤ 1. Concerning patients with pretherapeutic epilepsy, 84.6% of them were seizure-free at last follow-up. GKRS as first-line therapeutic option for unruptured cerebral AVMs achieves high obliteration rates (76%) while maintaining a high-level patient’s autonomy. All hemorrhagic events occurred during the first 4 years after the initial GKRS. In cases with epilepsy, there was 84.6% seizure free at last follow-up. Permanent morbidity was reported in only 4.6%.Show less >
Language :
Anglais
Popular science :
Non
Source :
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