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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Radiosurgery of arteriovenous malformations (AVM)

Meeting Abstract

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  • Klaus Hamm - CyberKnife Zentrum Mitteldeutschland
  • Gunnar Surber - CyberKnife Zentrum Mitteldeutschland
  • Rüdiger Gerlach - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.05.04

doi: 10.3205/14dgnc139, urn:nbn:de:0183-14dgnc1393

Published: May 13, 2014

© 2014 Hamm 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: 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.