More II it than meets the eye: Outcomes after single-fraction stereotactic radiosurgery in a case series of low-grade arteriovenous malformations

Christopher S. Graffeo, Michael Link, Scott L. Stafford, Yolanda I. Garces, Robert Foote, Bruce E. Pollock

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Surgical resection is typically cited as the optimal treatment of patients with Spetzler-Martin Grade I-II arteriovenous malformation (AVM). OBJECTIVE: To report our experience with single-fraction stereotactic radiosurgery (SRS) for Spetzler-Martin Grade I-II AVM. METHODS: A prospectively maintained registry was reviewed for patients with nonsyn-dromic Spetzler-Martin Grade I-II AVM having SRS from 1990 to 2011. Patients with <24 mo of follow-up or prior radiotherapy/SRS were excluded, resulting in a study population of 173 patients. Actuarial analysis was performed using the Kaplan-Meier method, and Cox proportional hazards modeling was performed with excellent outcomes (obliteration without new deficits) as the dependent variable. RESULTS: Median post-SRS follow-up was 68 mo (range, 24-275). AVM obliteration was achieved in 132 (76%) after initial SRS. Eleven additional patients achieved obliteration after repeat SRS for an overall obliteration rate of 83%. The rate of obliteration was 60% at 4 yr and 78% at 8 yr. Post-SRS hemorrhage occurred in 7 patients (4%), resulting in 3 minor deficits (2%) and 1 death (<1%). Radiation-induced complications occurred in 5 patients (3%), resulting in minor deficits only. One hundred and thirty-seven patients (79%) had excellent outcomes at last follow-up. CONCLUSION: SRS is a safe and effective treatment for patients with Spetzler-Martin Grade I-II AVM. Selection bias is likely a contributing factor to explain the superior outcomes generally noted in reported series of microsurgery for patients with low grade AVM.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalOperative Neurosurgery
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2020

Keywords

  • Arteriovenous malformation
  • Microsurgery
  • Spetzler-martin grade I
  • Spetzler-martin grade II
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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