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Updated: May 18, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Linear accelerator radiosurgery for brainstem arteriovenous malformations. Long-term results].
Luis Lorenzana1, Kita Sallabanda, José Samblás
1Unidad de Radiocirugía-Neurooncología, Hospital San Francisco de Asís, Grupo IMO, Madrid, España.
Neurocirugia (Asturias, Spain)
|September 8, 2012
Summary
Stereotactic radiosurgery using a linear accelerator (LINAC) achieved a 59.5% obliteration rate for brainstem arteriovenous malformations (AVM). This treatment offers a viable therapeutic option with acceptable toxicity and survival rates for these complex vascular lesions.
Area of Science:
- Neurosurgery
- Radiology
- Vascular Neurology
Background:
- Brainstem arteriovenous malformations (AVM) present significant risks of hemorrhage, mortality, and morbidity.
- Limited treatment options exist, primarily relying on stereotactic radiosurgery.
- Long-term outcomes of stereotactic radiosurgery for brainstem AVM require further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of linear accelerator (LINAC)-based stereotactic radiosurgery for brainstem AVM.
- To analyze long-term outcomes including obliteration rates, rebleeding, survival, and treatment toxicity.
- To determine factors influencing treatment success in brainstem AVM patients.
Main Methods:
- Retrospective analysis of 41 consecutive patients with brainstem AVM treated with 6MV LINAC radiosurgery (1992-2010).
- Data collected included lesion location, treatment details (margin dose, multiple procedures), and follow-up.
- Outcomes assessed were radiological obliteration (angiography/MRA), rebleeding rates, survival, and neurological deficits.
Main Results:
- A 59.5% obliteration rate was confirmed in 38 patients, with a mean follow-up of 61 months.
- 39% of patients required multiple radiosurgery sessions; no correlation found with dose, hemorrhage, diameter, or grading.
- Annual hemorrhage rate post-treatment was 3.2%, with 88% actuarial survival at 5 and 10 years; toxicity was low (2.6% permanent deficit).
Conclusions:
- Stereotactic radiosurgery with a moderate-dose protocol can achieve high obliteration rates for brainstem AVM.
- This approach balances the need for maximum obliteration with minimal morbidity in critical brainstem locations.
- LINAC-based stereotactic radiosurgery represents a potentially elective therapeutic option for brainstem AVM patients.
