gms | German Medical Science

Objective: Microsurgical resection, endovascular embolization, radiosurgery (RS) or a combination of these methods represent the available treatment options for arteriovenous malformations (AVM). The objective was to evaluate the results of RS for treatment of cerebral AVMs.

Method: Single institution data consisting of 72 patients (age: 11–76, median 62 years), treated with RS between 04/2000 and 04/2010) were evaluated. 22 patients suffered from bleeding before RS was performed, 17 patients presented with seizures, 12 with hemiparesis and 5 with aphasia or vertigo, respectively. 5 patients underwent microsurgical resection and 23 partial embolizations before RS. The mean nidus volume was 3.8 cm³ (0.2–17 cm³). The median radiation dose delivered to the margin was 16 Gy (13–22.5 Gy). Mean follow-up period was 38 months (14–96 months). Data of 59 patients were available for follow-up, 13 patients were lost to follow-up.

Results: Angiographic follow-up was performed in 32 patients demonstrating complete AVM obliteration in 29 cases. 3 patients with a detected residual AVM underwent repeated RS. Concerning 3D-MRI and 3D-TOF-MRA, 47 of the 59 patients (79,7%) showed complete obliteration of the AVM (no flow). In the other 12 cases (20,3%) a partial obliteration with reduction of blood flow was seen. 1 patient had a hemorrhage 4 months after RS. Adverse radiation effects were observed at follow-up MRI in 28 patients (47,5%), which were classified as mild in 15, moderate in 11 and severe in 2 patients. Temporary worsening of their symptoms occurred in 23 patients, among them 9 with additional symptoms.

Conclusions: RS leads to high rates of obliteration with acceptable risk of morbidity, especially in small AVMs. Following RS, radiation effects are detectable in MRI and can lead to misinterpretations. Therefore a close interdisciplinary cooperation is mandatory.