Radiosurgery for Cerebral Arteriovenous Malformations in Elderly Patients: Effect of Advanced Age on Outcomes After Intervention

Dale Ding, Zhiyuan Xu, Chun-Po Yen, Robert M. Starke, Jason P. Sheehan

Cerebral arteriovenous malformations (AVM) are infrequently diagnosed and treated in elderly patients (age >60 years). We hypothesize that, in contrast to AVM surgical outcomes, radiosurgery outcomes are not adversely affected by increased age. The goals of this case-control study are to analyze the radiosurgery outcomes for elderly AVM patients and determine the effect of elderly age on AVM radiosurgery outcomes. We evaluated a prospective database of AVM patients treated with radiosurgery from 1989-2013. Elderly AVM patients (age ≥60 years) with radiologic follow-up ≥2 years or nidus obliteration were selected for analysis, and matched, in a 1:1 fashion and blinded to outcome, to adult non-elderly AVM patients (age <60 years). Statistical analyses were performed to determine actuarial obliteration rates and evaluate the relationship between elderly age and AVM radiosurgery outcomes. The matching processes yielded 66 patients in each of the elderly and non-elderly AVM cohorts. In the elderly AVM cohort, the actuarial AVM obliteration rates at 3, 5, and 10 years were 37%, 65%, and 77%, respectively; the rates of radiologically evident, symptomatic, and permanent radiation-induced changes (RIC) were 36%, 11%, and 0%, respectively; the annual post-radiosurgery hemorrhage risk was 1.1%, and the AVM-related mortality rate was 1.5%. Elderly age was not significantly associated with AVM obliteration, RIC, or post-radiosurgery hemorrhage. Advanced age does not appear to confer appreciably worse AVM radiosurgery outcomes, unlike its negative effect on AVM surgical outcomes. Thus, when an AVM warrants treatment, radiosurgery may be the preferred treatment for elderly patients.