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A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas.

Authors
  • Mohammed, Nasser1
  • Hung, Yi-Chieh1
  • Chen, Ching-Jen1
  • Xu, Zhiyuan1
  • Schlesinger, David1
  • Kano, Hideyuki2
  • Chiang, Veronica3
  • Hess, Judith3
  • Lee, John4
  • Mathieu, David5
  • Kaufmann, Anthony M6
  • Grills, Inga S7
  • Cifarelli, Christopher P8
  • Vargo, John A8
  • Chytka, Tomas9
  • Janouskova, Ladislava9
  • Feliciano, Caleb E10
  • Mercado, Rafael Rodriguez10
  • Lunsford, L Dade4
  • Sheehan, Jason P1
  • 1 Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
  • 2 Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 3 School of Medicine, Yale University, New Haven, Connecticut.
  • 4 Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • 5 Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada. , (Canada)
  • 6 Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada. , (Canada)
  • 7 Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
  • 8 Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia.
  • 9 Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic. , (Czechia)
  • 10 Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico. , (Puerto Rico)
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
247–255
Identifiers
DOI: 10.1093/neuros/nyz401
PMID: 31584074
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS). To design a practical grading system that would predict outcomes after SRS for cranial dAVFs. From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified. Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan-Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001). The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems. Copyright © 2019 by the Congress of Neurological Surgeons.

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