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Effect of Advanced Age on Stereotactic Radiosurgery Outcomes for Brain Arteriovenous Malformations: A Multicenter Matched Cohort Study.

Abstract：

BACKGROUND:The effect of age on adult brain arteriovenous malformation (AVM) outcomes after stereotactic radiosurgery (SRS) remains unclear. The aim of this study is to compare AVM outcomes between elderly (age ≥60 years) and nonelderly adult patients. METHODS:We retrospectively reviewed pooled data comprising patients who underwent SRS for AVMs between 1987 and 2014 at 8 centers participating in the International Gamma Knife Research Foundation. Adult (age ≥18 years) patients with ≥12 months follow-up were dichotomized into elderly and nonelderly cohorts, and matched in a 1:1 ratio. Favorable outcome was AVM obliteration without permanent symptomatic radiation-induced changes (RIC) or post-SRS hemorrhage. RESULTS:The study cohort consisted of 1845 patients (188 elderly vs. 1657 nonelderly) who met the inclusion criteria, and subsequent matching resulted in 181 patients in each cohort. In the matched cohorts, rates of obliteration (54.7% vs. 64.6%; P = 0.054) favorable outcome (51.4% vs. 61.3%; P = 0.056) were no different between the elderly and nonelderly cohorts. The rates of post-SRS hemorrhage (9.9% vs. 5.5%; P = 0.115), RIC (26.5% vs. 30.9%; P = 0.353), symptomatic RIC (9.4% vs. 9.4%; P = 1.000), and permanent symptomatic RIC (3.3% vs. 2.2%; P = 0.750) were also not significantly different between the elderly and nonelderly cohorts. Elderly patients with AVM did have a significantly higher rate of all-cause mortality (27.7% vs. 5.5%; P < 0.001). CONCLUSIONS:Advanced age does not seem to significantly affect obliteration or complication rates after SRS for AVMs. Although the decision to recommend intervention for AVMs in the elderly population is multifactorial, SRS may be a viable modality when treatment is deemed appropriate.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Chen CJ,Ding D,Kano H,Mathieu D,Kondziolka D,Feliciano C,Rodriguez-Mercado R,Sheehan DE,Grills IS,Barnett G,Lunsford LD,Sheehan JP

doi

10.1016/j.wneu.2018.07.178

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

e429-e440

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)31656-5

journal_volume

119

pub_type

杂志文章,多中心研究

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Effect of Advanced Age on Stereotactic Radiosurgery Outcomes for Brain Arteriovenous Malformations: A Multicenter Matched Cohort Study.