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Updated: May 27, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Staged gamma knife radiosurgery for large cerebral arteriovenous malformations
Kwame Amponsah1, Thomas L Ellis, Michael D Chan
1Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA. namponsa@wfubmc.edu
Background:
We present our experience over a 10-year period of staged radiosurgery for large arteriovenous malformations (AVMs) including patient outcomes and methods.
Methods:
From July 2000 to December 2010, 80 patients with AVMs were treated with gamma knife radiosurgery (GKS) at our institution; of these patients, 5 were treated for large AVMs with staged GKS (volumes >20 cm(3)). The mean interval between treatments was 10 months (range 7-16). The mean dose for the margin used was 18.0 Gy (range 16-20). The mean volume treated was 37.2 cm(3) (range 22-50). The mean total follow-up was 76.5 months (range 42-120).
Results:
Two patients had complete obliteration of the AVM nidus. One patient had 95% obliteration (31 months after radiosurgery), one had 90% obliteration (38 months after radiosurgery), and one had less than 50% obliteration at 53 months with a 16-month interval between staged treatments.
Conclusions:
Staged radiosurgery is an effective and safe method for the treatment of large AVMs. We report achieving higher marginal doses with staging in planned intervals of 6-9 months between staged treatments. It appears that the longer the wait between treatments, the less likely it is that complete obliteration will be achieved.
