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Updated: Mar 26, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Microsurgical Resection for Persistent Arteriovenous Malformations Following Gamma Knife Radiosurgery: A Case-Control
Xianzeng Tong1, Jun Wu1, Jian Pan2
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China.
Objective:
To explore outcomes after microsurgery of brain arteriovenous malformations (AVMs) that failed to be obliterated by Gamma Knife radiosurgery (GKRS).
Methods:
From January 2000 to January 2014, 42 consecutive patients underwent surgical resection of persistent AVMs after GKRS. These 42 patients with AVMs who underwent radiosurgery (radiosurgery group) were individually matched with 42 patients with AVMs who did not undergo radiosurgery (no radiosurgery group) based on patient and AVM characteristics. The modified Rankin Scale was used to assess neurologic status of patients. The effects of GKRS on AVM resection and surgical outcomes were analyzed.
Results:
After GKRS, the mean AVM volume was significantly reduced by 76.8% (P < 0.01), the size was reduced by 41% (P < 0.01), and the Spetzler-Martin grade was reduced in 61.9% of the patients (P < 0.01). During the time interval from radiosurgery to surgical resection, subsequent hemorrhages led to significant neurologic deterioration (P = 0.046). Compared with the control group, the frequency of preoperative embolization, operative time, and blood loss were significantly lower in the radiosurgery group (all P < 0.05). The no radiosurgery group had a significantly higher rate of worsening in mRS scores at 6 months after surgery (40.5% vs. 16.7%, P = 0.029). Good neurologic status (mRS score <3) was achieved in 81% of the radiosurgery group and 83% of the no radiosurgery group at the final follow-up evaluation.
Conclusions:
GKRS performed several years before microsurgical resection can facilitate resectability of AVMs and decrease the rate of postoperative neurologic deterioration. For patients with persistent AVMs several years after GKRS, microsurgical resection is recommended to achieve good clinical outcomes.
Insights
Microsurgery after Gamma Knife radiosurgery (GKRS) for brain arteriovenous malformations (AVMs) facilitates resection and reduces postoperative deterioration. This approach is recommended for persistent AVMs to achieve good outcomes.
Area of Science:
- Neurosurgery
- Radiosurgery
- Vascular Neurology
Background:
- Brain arteriovenous malformations (AVMs) pose significant risks.
- Gamma Knife radiosurgery (GKRS) is a treatment option for AVMs.
- Some AVMs remain after GKRS, requiring further intervention.
Purpose of the Study:
- To evaluate outcomes of microsurgical resection for AVMs that did not achieve obliteration with prior GKRS.
- To compare surgical outcomes between patients who had GKRS before resection and those who did not.
Main Methods:
- A retrospective review of 42 patients who underwent AVM resection after GKRS (radiosurgery group).
- Matching these patients with 42 AVM patients who did not receive radiosurgery (no radiosurgery group).
- Assessment of neurologic status using the modified Rankin Scale (mRS) and analysis of surgical outcomes.
Main Results:
- GKRS significantly reduced AVM volume (76.8%), size (41%), and Spetzler-Martin grade.
- The radiosurgery group had lower rates of preoperative embolization, operative time, and blood loss.
- The no radiosurgery group showed a higher rate of mRS score worsening at 6 months (40.5% vs. 16.7%).
Conclusions:
- Performing GKRS years before microsurgical resection can improve AVM resectability and lower postoperative neurologic deterioration.
- Microsurgical resection is a recommended strategy for persistent AVMs several years after GKRS to achieve favorable clinical outcomes.
