The rationale and technique of staged-volume arteriovenous malformation radiosurgery

Bruce E. Pollock, Robert W. Kline, Scott L. Stafford, Robert L. Foote, Paula J. Schomberg

Research output: Contribution to journalArticle

93 Scopus citations


Purpose: Stereotactic radiosurgery is an effective management strategy for properly selected arteriovenous malformation (AVM) patients. However, the risk of postradiosurgical radiation-related injury generally limits this procedure to patients with AVMs of an average diameter of 3 cm or less. Radiosurgery of large AVMs in a planned staged fashion was undertaken to limit the radiation exposure to the surrounding normal brain. Methods and Materials: Between April 1997 and December 1999, 10 patients with a median AVM volume of 17.4 cm3 (range, 7.4-53.3 cm3) underwent staged-volume radiosurgery (23 procedures). At the first radiosurgical procedure, the total volume of the AVM is estimated and a dose plan calculated that covers 10 cm3-15 cm3, or one-half the nidus volume if the AVM is critically located (brainstem, thalamus, or basal ganglia). At 6-month intervals thereafter, radiosurgery was repeated to different portions of the AVM with the previous dose plan(s) being re-created utilizing intracranial landmarks to minimize radiation overlap. Radiosurgical procedures were continued until the entire malformation has been irradiated. Results: The radiation dosimetry of staged- volume AVM radiosurgery was compared to hypothetical single-session procedures for the 10 patients. Staged-volume radiosurgery decreased the 12- Gy volume by an average of 11.1% (range, 4.9-21%) (p < 0.001). The non-AVM 12-Gy volume was reduced by an average of 27.2% (range, 12.5-51.3%) (p < 0.001). Discussion: Staged-volume radiosurgery of large AVMs results in less radiation exposure to the adjacent brain. Further follow-up is needed to determine whether this technique provides a high rate of AVM obliteration while maintaining an acceptable rate of radiation-related complications. (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)817-824
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3
StatePublished - Oct 1 2000


  • Arteriovenous malformation
  • Complication
  • Radiation
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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