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Updated: Sep 3, 2025
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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Repeat stereotactic radiosurgery for cerebral arteriovenous malformations.
Neurosurgical Focus
|July 28, 2022
Summary
Repeat stereotactic radiosurgery (SRS) offers a viable treatment for residual arteriovenous malformations (AVMs). Favorable outcomes are seen in adults and smaller AVMs, with higher doses improving obliteration rates.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Radiology
Background:
- Cerebral arteriovenous malformations (AVMs) can persist after initial treatment.
- Repeat stereotactic radiosurgery (SRS) is considered for residual AVMs.
- Evaluating outcomes of repeat SRS is crucial for treatment optimization.
Purpose of the Study:
- To assess radiological and clinical outcomes of repeat SRS for residual cerebral AVMs.
- To identify factors influencing AVM obliteration and complications after repeat SRS.
Main Methods:
- Retrospective, single-institution study.
- Inclusion of 170 patients undergoing repeat SRS for AVM between 1989 and 2021.
- Analysis of AVM obliteration rates, hemorrhage, and radiation-induced changes.
Main Results:
- 3-, 5-, and 10-year AVM obliteration rates were 37.6%, 57.3%, and 80.9%.
- Higher obliteration associated with margin dose ≥ 19 Gy; risk factors for hemorrhage include age < 18 and AVM diameter > 20 mm.
- Radiation-induced changes occurred in 39.0% of patients, with 1 case of meningioma.
Conclusions:
- Repeat SRS is a reasonable option for residual AVMs, particularly in adults and smaller AVMs.
- Higher obliteration rates are linked to doses ≥ 19 Gy.
- Careful patient selection and dose optimization are important for repeat SRS.
