gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Factors influencing the obliteration rate of cerebral arteriovenous malformations after Gamma-Knife radiosurgery

Meeting Abstract

  • P. Meid - Klinik für Radiologie und Nuklearmedizin, Medizinisches Zentrum Städteregion Aachen
  • M. Mull - Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum der RWTH Aachen, Aachen
  • A. van Osterhout - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen
  • F.J. Hans - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen
  • A. Thron - Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum der RWTH Aachen, Aachen
  • B.C. Huffmann - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.04

doi: 10.3205/11dgnc069, urn:nbn:de:0183-11dgnc0694

Published: April 28, 2011

© 2011 Meid et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: To determine the influence of several factors on the chance of obliteration after Gamma-Knife-radiosurgery for cerebral arteriovenous malformations (cAVM).

Methods: Angiographic follow-up (FU) was available for 101 of 162 cAVM in 156 Patients (72 female, 84 male; mean age 35.3 years, range 3-78) that were treated with Gamma-Knife radiosurgery between July 1998 and July 2005 (mean FU-time 37.3 months, range 15-101). 5 of those were re-treatments. Complete clinical FU-information was obtainable for 136 patients. 54 angiomas (33.3%) were previously embolized at least once. Main presenting symptoms were previous hemorrhage (46.9%), seizures (27.7%), sensorimotor deficits (24.7%) and headache (11.1%). Mean volume before treatment was 3.69 cm3 (0.021-12.9 cm3), the Spetzler-Martin-Grades ranged from 1 to 4. The parameters analyzed were previous embolization, patient age and gender, nidus volume and maximum diameter, minimum and maximum dose, previous hemorrhage and the Spetzler-Martin grade.

Results: The angiographically confirmed overall obliteration rate was 72.3%. For patients with previous embolization, it was statistically significant lower than for those without (54.3% vs. 81.8%, p=0.005). Small lesions obliterated more often than mid-sized lesions (77.6% vs. 56.0%, individual p=0.043), but after Bonferroni correction for multiple testing, this was not significant. All other factors had no statistically significant influence. During the latency period, 9 hemorrhages occurred in 8 cAVM (mean time 16.1, range 6-36 months after treatment) resulting in an overall bleeding rate of 6.4% (no permanent morbidity, no mortality). Permanent new neurological deficits occurred in 2 patients (1.5%).

Conclusions: Gamma-Knife radiosurgery is a safe treatment method for cAVM that led to angiographically confirmed obliteration in 72.3% of the study population. Due to its statistically firm negative influence on the probability of obliteration, the indications for pre-radiosurgical embolization should be reconsidered.