Linac-based stereotactic radiosurgery for brain arteriovenous malformations

Area of Science:

• Neurosurgery
• Radiation Oncology
• Vascular Neurology

Background:

• Linac-based stereotactic radiosurgery (SRS) is increasingly used for cerebral arteriovenous malformations (AVMs).
• Uncertainty surrounds combined radiosurgical and endovascular treatments, driving interest in SRS.
• Technical advancements have improved SRS efficacy and safety.

Purpose of the Study:

• Evaluate obliteration and re-bleeding rates after linac-based SRS for AVMs.
• Identify factors influencing obliteration.
• Assess adverse effects of SRS on AVM patients.

Main Methods:

• Retrospective analysis of 71 patients with cerebral AVMs treated with SRS.
• Patients included those with prior embolization (31), surgery (5), or no prior treatment (29).
• Kaplan-Meier survival and life table analyses used to calculate obliteration and bleeding rates.

Main Results:

• Actual obliteration rates were 22% (1 year), 59% (2 years), and 66% (3 years).
• Prior embolization did not affect obliteration rates.
• Annual bleeding hazard rates were 2.1% (year 1) and 1.4% (year 2).
• Asymptomatic abnormalities detected in 33.9% of patients post-imaging.
• Doses <18 Gy significantly reduced obliteration probability.

Conclusions:

• SRS is a viable therapeutic option for intracerebral AVMs.
• SRS offers a low morbidity rate.
• High probability of nidus obliteration is achievable with SRS.