Radiosurgery for ruptured intracranial arteriovenous malformations

Area of Science:

• Neurosurgery
• Radiation Oncology
• Vascular Neurology

Background:

• Ruptured intracranial arteriovenous malformations (AVMs) pose a significant risk of re-hemorrhage, necessitating effective treatment.
• Radiosurgery is a key treatment modality for ruptured AVMs, but outcomes require careful evaluation.

Purpose of the Study:

• To evaluate the outcomes of radiosurgery in a large cohort of patients with ruptured intracranial arteriovenous malformations (AVMs).
• To identify predictors of obliteration and complications following radiosurgery for ruptured AVMs.

Main Methods:

• Retrospective analysis of a prospectively collected database of AVM radiosurgery.
• Inclusion of 565 patients with ruptured AVMs and at least 2 years of radiological follow-up.
• Analysis of obliteration rates, hemorrhage risk, and radiation-induced changes using survival and regression models.

Main Results:

• Overall obliteration rates reached 67.1% by combined modalities.
• Key predictors of obliteration included absence of embolization and higher prescription dose.
• Annual hemorrhage risk during latency was 2.0%; predictors of post-radiosurgery hemorrhage included decreased dose and multiple draining veins.

Conclusions:

• Radiosurgery offers an effective treatment for ruptured AVMs with an acceptable risk-benefit profile.
• Avoiding preradiosurgical embolization and utilizing higher prescription doses are associated with favorable outcomes.