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Radiosurgery for Arteriovenous Malformations and the Impact on Headaches
Author(s) -
Bowden Greg,
Cavaleri Jonathon,
Kano Hideyuki,
Monaco Edward,
Niranjan Ajay,
Flickinger John,
Dade Lunsford L.
Publication year - 2017
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13055
Subject(s) - medicine , headaches , radiosurgery , retrospective cohort study , medical record , arteriovenous malformation , intracranial arteriovenous malformations , adverse effect , surgery , angiography , radiation therapy , cerebral angiography
Background Arteriovenous malformations (AVMs) can underlie many diverse neurological signs and symptoms. Headaches are a common presentation that can have a significant impact on quality of life. Objective The authors investigated Gamma Knife ® stereotactic radiosurgery (SRS) outcomes in patients with AVMs and associated headaches. Methods This retrospective study analyzed 102 patients with AVMs who underwent SRS between 1995 and 2013. The patient's headache symptoms led to their AVM diagnosis or developed post hemorrhage of their AVM. Information regarding headache characteristics was obtained from the patient's medical records and at follow‐up using a scripted clinical interview. The median imaging follow‐up was 61.7 months and clinical follow‐up was 89.7 months. The median treatment volume at SRS was 4.1 cm 3 and the median marginal dose was 20 Gy. Results The actuarial AVM obliteration rate was 60% at 5 years and 78% at 10 years. Patients reported that their overall headache severity decreased by −43.6% and their headache frequency was reduced by −53.4%. Headache reduction was reported in 49.1% of patients at 1 year and 69.5% at 5 years. The median time until improvement was 6.5 months. After SRS, headache medication usage decreased in 29% of patients. Permanent adverse radiation effects after SRS occurred in 3% of patients. Until obliteration was complete, the annual risk of a hemorrhage after SRS was 0.4% per year. Conclusion Although recall bias related to a retrospective analysis can impact outcomes, headache symptoms associated with AVMs may potentially be decreased or eliminated in a subset of patients treated with Gamma Knife radiosurgery.