Introduction: Ruptured cerebral arteriovenous malformations (AVMs) are known to have a worse natural history then their unruptured counterparts; however the treatment modality of choice is controversial. This study investigates the safety and efficacy of stereotactic radiosurgery (SRS) for patients with ruptured AVMs.
Methods: A retrospective case review was conducted at a single center on 84 patients with ruptured AVMs were treated with SRS (76 patients (91%) with Gamma Knife Radiosurgery and 8 patients (9%) with LINAC) between 1996 and 2011. A survival, regression, and multivariate analysis were conducted to identify predictors of complications, re-rupture, and radiographic outcome.
Results: Of the 84 patients, the mean Spetzler-Martin (SM) grade was 2.95. The median volume was 1.73cc3, and the mean Pollock-Flickinger score was 1.65. Median radiographic follow up was 73 months. Twenty-one patients (25%) required more than one SRS session. Total angiographic obliteration rate was 48 of 71 patients (68%) with greater than 24 month follow-up (7 patients by MRI alone). Multivariate predictors of obliteration were smaller volumes and superficial venous drainage. Pollock-Flickinger scale (LR chi2= 10.97) was slightly more predictive of obliteration than SM scale (LR chi2=9.68). While there were no multivariate predictors of re-hemorrhage in 11 patients (13%), increasing SM grade, increasing volumes, and those that did not become obliterated in the future were univariate predictors. Endovascular embolization was not a predictor of complications, re-hemorrhage, or radiographic outcome.
Conclusions: SRS is a safe and effective treatment modality in ruptured AVMs that are not surgical candidates.
Patient Care: This research will identify the efficacy, safety, and re-hemorrhage rates of stereotactic radiosurgery for challenging ruptured cerebral arteriovenous that are not surgical canindates.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of treatment of ruptured cerebral arteriovenous malformations, 2) Identify an effective treatment of these lesions, including stereotactic radiosurgery and be able to discuss its risks and benefits.