Seizure Presentation in Patients With Brain Arteriovenous Malformations Treated With Stereotactic Radiosurgery: A Multicenter Study

Abstract

Abstract INTRODUCTION Seizures are the second most common clinical presentation in patients with brain arteriovenous malformations (AVMs), and they are the most common presentation of unruptured AVMs. The aim of this multicenter, retrospective cohort study was to identify predictors of seizure presentation in AVM patients treated with stereotactic radiosurgery (SRS). METHODS We performed a retrospective review of AVM patients treated with SRS at 8 participating International Radiosurgery Research Foundation sites. Patient and AVM characteristics were compared between those with versus without a seizure presentation in univariable and multivariable models. Subgroup analysis of patients with cortical AVMs was performed. RESULTS The study cohort comprised 2333 AVM patients, including 419 (18%) with and 1914 (82%) without a seizure presentation. Prior AVM resection (OR = 7.65, P = .001), lack of prior AVM hemorrhage (OR = 0.004, P < .001), cortical AVM location (OR = 1559.42, P < .001), lower Spetzler-Martin (SM) grade (OR = 0.51, P = .007), and higher Virginia Radiosurgery AVM Score (VRAS; OR = 1.46, P = .008) were independent predictors of seizure presentation. The rate of seizure presentation in patients with cortical AVMs was 27%. Prior AVM resection (OR = 8.36, P < .001), lack of prior AVM hemorrhage (OR = 0.004, P < .001), and temporal AVM location (OR = 4.15, P < .001) were independent predictors of seizure presentation for cortical AVMs. CONCLUSION We identified multiple factors associated with seizure presentation in AVM patients selected to undergo SRS. Prior AVM resection, cortical AVM location, and lack of prior AVM hemorrhage were the strongest predictors of pre-SRS seizures. SM grade and VRAS may have a role in seizure risk stratification. Among cortical AVMs, temporal lobe localization was predictive of seizure presentation.