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Haemorrhage in arteriovenous malformations of the brain following radiosurgery: the importance of the latency period

P. Varela-Rois, P. Martínez-Cueto, A. López-Medina, M. Caeiro-Muñoz, F. Salvador-Gómez, V. Muñoz-Garzón, J.M. Otero-Vich [REV NEUROL 2008;47:403-409] PMID: 18937201 DOI: https://doi.org/10.33588/rn.4708.2008411

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Volumen 47 | Number 08 | Nº of views of the article 5.781 | Nº of PDF downloads 335 | Article publication date 16/10/2008

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ABSTRACT

INTRODUCTION Arteriovenous malformations are abnormal communications between arteries and veins. Treatment can consist in surgery, embolisation and/or radiosurgery.

AIM To assess the influence of radiosurgery on the risk of bleeding and related factors.

PATIENTS AND METHODS Retrospective study of 79 patients who were treated with a 6 MV linear accelerator. Clinical, morphological and dosimetric parameters were collected and a statistical analysis was performed to investigate their relationship with bleeding during the latency period.

RESULTS The mean age was 33.7 years, and 56% of patients were females. The mean volume was 6.16 cm3. Bleeding occurred before treatment in 52.6% of cases. Altogether 25% had been embolised and 7.6% had been treated earlier using radiosurgery. Six patients suffered a haemorrhage after treatment. Bleeding occurred in 21% of those who had undergone embolisation versus 3.6% in non-embolised individuals (p < 0.02). Bleeding occurred in 33.3% of those who had been treated radiosurgically on more than one occasion, and only 5.7% if they were treated just once (p = 0.02). Bleeding took place in 28.6% of lesions above 10 cm3 and in 3.2% when they were smaller (p < 0.01). Bleeding occurred in 16.1% of patients if they received less than 17 Gy, and in 2.22% if they received 17 or more (p < 0.01). All haemorrhages took place in treatments with more than one isocentre (p < 0.01) and with a higher homogeneity index (p < 0.01).

CONCLUSIONS Radiosurgery does not modify the risk of bleeding. The factors associated to higher percentages of bleeding are also related to poorer closure outcomes and longer latency periods. KeywordsAcelerador lineal Angiografía cerebral Dosimetría Hemorragia cerebral Malformaciones arteriovenosas cerebrales Radiocirugía estereotáctica

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Haemorrhage in arteriovenous malformations of the brain following radiosurgery: the importance of the latency period

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