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Related Experiment Video

Updated: May 22, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
14:58

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Published on: October 20, 2017

Stereotactic radiosurgery for arteriovenous malformations after embolization: a case-control study.

Hideyuki Kano1, Douglas Kondziolka, John C Flickinger

  • 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

Journal of Neurosurgery
|May 29, 2012
PubMed
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Prior embolization before stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) reduced obliteration rates but did not increase hemorrhage risk. Success improved for AVMs smaller than 8 cm(3) with higher SRS doses.

Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Vascular Neurology

Background:

  • Arteriovenous malformations (AVMs) pose risks of hemorrhage and neurological deficits.
  • Stereotactic radiosurgery (SRS) is a treatment option for AVMs.
  • Prior embolization is sometimes used in conjunction with SRS.

Purpose of the Study:

  • To evaluate the long-term benefits and risks of SRS for AVMs previously treated with embolization.
  • To compare outcomes of SRS with and without prior embolization.

Main Methods:

  • Retrospective analysis of 120 patients who underwent embolization followed by SRS (Gamma Knife surgery) between 1987 and 2006.
  • Comparison with patients who underwent SRS without prior embolization.
  • Assessment of AVM obliteration rates, hemorrhage events, and adverse radiation effects (AREs).

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Main Results:

  • Prior embolization was associated with a lower rate of total AVM obliteration (p = 0.028).
  • Hemorrhage risk during the latency period and AREs were not significantly affected by prior embolization.
  • AVM obliteration success improved for embolized volumes < 8 cm(3) and margin doses ≥ 18 Gy.
  • Overall obliteration rates were 59% at 10 years; annual hemorrhage rate was 2.7%.

Conclusions:

  • Prior embolization decreases SRS obliteration rates for AVMs but does not elevate hemorrhage or ARE risks.
  • Optimizing embolization volume and SRS margin dose can improve outcomes.
  • Further research into the role of embolization in conjunction with SRS is warranted.