gms | German Medical Science

Objective: Intracranial arteriovenous malformations (AVM) may be suitable for one or more of four management strategies: observation, surgical excision, stereotactic radiosurgery or endovascular embolization. We report on 72 cases with small to medium-sized AVMs treated with stereotactic radiosurgery.

Methods: The study includes 72 patients (39 women, 33 men, mean age 34) treated with Gamma Knife radiosurgery (GKRS) for whom conclusive angiograms were obtained two to three years after the treatment. The initial symptom was haemorrhage in 35 cases, epilepsy in 18 and headache in 8. Twenty-five patients were embolized, 7 operated prior to radiosurgery. The mean AVM nidus volume was 3,8 cm³ (0,2-12,9 cm³). Fifty AVMs were found in eloquent areas with 18 in deep (thalamus/basal ganglia, midbrain/brainstem) brain locations. When obliteration was assumed in MRI, final angiography was performed. Total obliteration was defined as a complete absence of pathological vessels in the former nidus of the malformation, disappearance or normalization of draining veins, and normal circulation time.

Results: Two to three years after GKRS 48 AVM were obliterated, 6 patients presented an early filling vein only. Eight patients were free from epileptic seizures, one without, one with less medication. Postradiosurgical haemorrhages were observed in 3 cases: in two patients the residual nidi were resected, in the third the AVM was obliterated two years after GKRS without further treatment. Transient imaging changes were symptomatic in four patients. Permanent complications were found in two patients with deeply located AVMs which were both obliterated 2 years after treatment.

Conclusions: GKRS provides satisfactory results for AVM cure with few complications. Radiosurgery is most appropriate for small to medium-sized AVMs, especially when these are situated in eloquent and/or deep brain locations.