Volume-staged stereotactic radiosurgery for intracranial arteriovenous malformations: Outcomes based on an 18-year experience

Bruce E. Pollock, Michael J. Link, Scott L. Stafford, Giuseppe Lanzino, Yolanda Isabel Garces, Robert L. Foote

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

BACKGROUND: Radiation-based treatment options of large intracranial arteriovenous malformations (AVM) must balance the likelihood of obliteration with the risk of adverse radiation effects (ARE). OBJECTIVE: To analyze the efficacy and risks of volume-staged stereotactic radiosurgery (VS-SRS) for AVM. METHODS: Retrospective study of 34 AVM patients having VS-SRS between 1997 and 2012. A median of 2 stages (range, 2-4) was used to treat a median AVM volume of 22.2 cm3 (range, 7.4-56.7). The median AVM margin dose was 16 Gy (range, 14-18); the median radiosurgery-based AVM score was 2.81 (range, 1.54-6.45). The median follow-up after VS-SRS was 8.2 years (range, 3-13.3). RESULTS: Nidus obliteration was noted in 18 patients (53%) after VS-SRS. The rate of obliteration was 14% at 3 years, 54% at 5 years, and 75% at 7 years. Six patients (18%) had 11 bleeds after VS-SRS. Two patients (6%) remained neurologically stable, 2 (6%) patients had significant deficits, and 2 patients (6%) died. The actuarial risk of a first bleed after VS-SRS was 6% at 1 year, 12% at 3 years, and 19% at 7 years. Six patients (18%) underwent repeat SRS; all achieved nidus obliteration for an overall cure rate of 71%. Two patients (6%) had a permanent ARE after VS-SRS or repeat SRS. CONCLUSION: VS-SRS permitted large volume intracranial AVM to be treated with a low rate of ARE. Further study is needed on dose escalation and decreasing the treatment volume per stage to determine if this will increase the rate of obliteration with this technique.

Original languageEnglish (US)
Pages (from-to)543-549
Number of pages7
JournalClinical Neurosurgery
Volume80
Issue number4
DOIs
StatePublished - Apr 1 2017

    Fingerprint

Keywords

  • Arteriovenous malformation
  • Complication
  • Radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this