Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations
Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (AVM). Very few studies have addressed the concern of radiation injury to the brain and its attendant adverse effects on cognitive function. Materials and Methods: This prospective study included all patie...
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doaj-37e59868e66c4dd7aa62f394f2f7d3522021-04-02T12:08:46ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neurosciences in Rural Practice0976-31470976-31552016-01-01701283510.4103/0976-3147.172158Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformationsA. Raghunath0Niranjana Bennett1Arivazhagan Arimappamagan2Dhananjaya I. Bhat3Dwarakanath Srinivas4K. Thennarasu5R. Jamuna6Sampath Somanna7Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, IndiaBackground: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (AVM). Very few studies have addressed the concern of radiation injury to the brain and its attendant adverse effects on cognitive function. Materials and Methods: This prospective study included all patients who underwent gamma knife radiosurgery (GKRS) at our institute for cerebral AVM between 2006 and December 2008 (n = 34). All patients underwent neuropsychological evaluation before the procedure. Neuropsychological evaluation was repeated in eighteen patients 2 years following GKRS. Clinical outcome, AVM obliteration, and factors influencing outcome were analyzed in these eighteen patients. Results: Before GKRS, more than 50% had significant impairment of neuropsychological functions compared to normal population norms. 66.6% achieved the excellent radiosurgical outcome. At 2 years follow-up, patients showed varied improvement in neuropsychological function in various categories. Pretherapeutic median value for percentage perseverative responses was 26.5 and at follow-up, it reduced to 18.2 (P = 0.039). Set shifting improved in 11 patients (61.1%), remained same in 5 patients (27.7%), and deteriorated in two patients (11.1%). Patients with a higher Spetzler-Martin grade AVM demonstrated a significantly more favorable shift in follow-up test values for set shifting function (P = 0.021). Patients with postradiation imaging changes had lesser tendency to improve in neuropsychological performance at follow-up. Conclusions: GKRS has no clinically harmful effect on cognitive and neuropsychological functioning in patients with brain AVM. On the contrary, there is an improvement in majority of patients at 2 years following radiosurgery when nidus is obliterated.http://www.thieme-connect.de/DOI/DOI?10.4103/0976-3147.172158arteriovenous malformationcognitive effectsoutcomepostradiation edemaradiosurgery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
A. Raghunath Niranjana Bennett Arivazhagan Arimappamagan Dhananjaya I. Bhat Dwarakanath Srinivas K. Thennarasu R. Jamuna Sampath Somanna |
spellingShingle |
A. Raghunath Niranjana Bennett Arivazhagan Arimappamagan Dhananjaya I. Bhat Dwarakanath Srinivas K. Thennarasu R. Jamuna Sampath Somanna Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations Journal of Neurosciences in Rural Practice arteriovenous malformation cognitive effects outcome postradiation edema radiosurgery |
author_facet |
A. Raghunath Niranjana Bennett Arivazhagan Arimappamagan Dhananjaya I. Bhat Dwarakanath Srinivas K. Thennarasu R. Jamuna Sampath Somanna |
author_sort |
A. Raghunath |
title |
Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations |
title_short |
Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations |
title_full |
Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations |
title_fullStr |
Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations |
title_full_unstemmed |
Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations |
title_sort |
impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations |
publisher |
Thieme Medical and Scientific Publishers Pvt. Ltd. |
series |
Journal of Neurosciences in Rural Practice |
issn |
0976-3147 0976-3155 |
publishDate |
2016-01-01 |
description |
Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (AVM). Very few studies have addressed the concern of radiation injury to the brain and its attendant adverse effects on cognitive function. Materials and Methods: This prospective study included all patients who underwent gamma knife radiosurgery (GKRS) at our institute for cerebral AVM between 2006 and December 2008 (n = 34). All patients underwent neuropsychological evaluation before the procedure. Neuropsychological evaluation was repeated in eighteen patients 2 years following GKRS. Clinical outcome, AVM obliteration, and factors influencing outcome were analyzed in these eighteen patients. Results: Before GKRS, more than 50% had significant impairment of neuropsychological functions compared to normal population norms. 66.6% achieved the excellent radiosurgical outcome. At 2 years follow-up, patients showed varied improvement in neuropsychological function in various categories. Pretherapeutic median value for percentage perseverative responses was 26.5 and at follow-up, it reduced to 18.2 (P = 0.039). Set shifting improved in 11 patients (61.1%), remained same in 5 patients (27.7%), and deteriorated in two patients (11.1%). Patients with a higher Spetzler-Martin grade AVM demonstrated a significantly more favorable shift in follow-up test values for set shifting function (P = 0.021). Patients with postradiation imaging changes had lesser tendency to improve in neuropsychological performance at follow-up. Conclusions: GKRS has no clinically harmful effect on cognitive and neuropsychological functioning in patients with brain AVM. On the contrary, there is an improvement in majority of patients at 2 years following radiosurgery when nidus is obliterated. |
topic |
arteriovenous malformation cognitive effects outcome postradiation edema radiosurgery |
url |
http://www.thieme-connect.de/DOI/DOI?10.4103/0976-3147.172158 |
work_keys_str_mv |
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1721570025898246144 |