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Updated: Aug 16, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Intracranial arteriovenous malformations treated utilizing a linear accelerator-based patient rotator or commercially
Todd J Scarbrough1, Ian R Crocker, Lawrence W Davis
1The Melbourne Cancer Center, Melbourne, FL 32901, USA. todd.scarbrough@mima.com
Purpose:
To report a single-institution experience with intracranial arteriovenous malformations (AVMs) treated utilizing a linear accelerator-based patient rotator (PR) or BrainLAB (BL) radiosurgery system (BrainLAB AG, Heimstetten, Germany).
Methods And Materials:
Since 1989, 84 evaluable patients were treated. PR patients (n = 45) were planned/localized on the basis of biplane angiography and treated between 1989 and 2000. BL patients (n = 39) were planned/localized on the basis of CT/MRI and treated since 2000. Kaplan-Meier analyses of survival, nidus obliteration (NO), and any radiographic improvement were undertaken with Cox regression of dose and volume effects.
Results:
No significant complication, survival, previous embolization incidence, AVM location or size differences existed between BL/PR patients. The groups differed significantly in prescribed dose (PR: 16.2 Gy, BL: 17.3 Gy, p = 0.004) and isodose (PR: 62%, BL: 79%, p < 0.0001). Estimated 2-year NO rate was 87% for BL patients, 12% for PR patients (p < 0.0001). Ultimate PR NO rate was 67% at 6 years. Dose (p = 0.037) and isodose (p = 0.014) significantly affected PR NO outcome; volume was of borderline significance (p = 0.069). No factors significantly affected BL outcome. Analyses of small (< or = 4.0 cm3), high-dose (> or = 17.0 Gy) PR patients (PR1 group) vs. BL patients still demonstrated greater NO (p = 0.04) and radiographic improvement (p = 0.0004) rates for the BL group. PR1 patients had a 76% 3-year NO rate.
Conclusions:
BL-based radiosurgery achieved a high NO rate, the PR method did not. Differences in outcomes between PR/BL groups may be due to localization methods or an inherent advantage with the BL system.
