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  • Stereotactic Radiosurgery for Brainstem Arteriovenous Malformations: A Multicenter Study.

    Final Number:

    Or Cohen-Inbar MD PhD; Robert M. Starke MD, MSc; Cheng-Chia Lee; Hideyuki Kano MD PhD; Paul P Huang MD; Douglas Kondziolka MD MSc FRCS(C) FACS; Inga S. Grills MD; Danilo Silva MD; Mahmoud Aly Abbassy; Symeon Missios MD; Gene H. Barnett MD; L. Dade Lunsford MD; Jason P. Sheehan MD PhD FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: e management of brainstem arteriovenous malformations (bAVMs) is a formidable challenge. bAVMs harbor higher morbidity and mortality compared to other locations.

    Methods: Six medical centers contributed data from 205 patients through the International Gamma Knife Research Foundation. Median age was 32 yr (6-81). Median nidus volume was 1.4 mL (0.1-69 mL). Favorable outcome (FO) was defined as AVM obliteration and no post-treatment hemorrhage or permanent symptomatic radiation-induced complications.

    Results: Overall obliteration was reported in 65.4% (n = 134) at a mean follow-up of 69 mo. Obliteration was angiographically proven in 53.2% (n = 109) and on MRA in 12.2% (n = 25). Actuarial rate of obliteration at 2, 3, 5, 7, and 10 yr after SRS was 24.5%, 43.3%, 62.3%, 73%, and 81.8% respectively. Patients treated with a margin dose >20 Gy were more likely to achieve obliteration ( P = .001). Obliteration occurred earlier in patients who received a higher prescribed margin dose ( P = .05) and maximum dose ( P = .041). Post-SRS hemorrhage occurred in 8.8% (n = 18). Annual postgamma knife latency period hemorrhage was 1.5%. Radiation-induced complications were radiologically evident in 35.6% (n = 73), symptomatic in 14.6% (n = 30), and permanent in 14.6% (n = 30, which included long-tract signs and new cranial nerve deficits). FO was achieved in 64.4% (n = 132). Predictors of an FO were a higher Virginia radiosurgery AVM scale score ( P = .003), prior hemorrhage ( P = .045), and a lower prescribed maximum dose ( P = .006).

    Conclusions: SRS for bAVMs results in obliteration and avoids permanent complications in the majority of patients.

    Patient Care: Brainstem AVM's are a multidisciplinary treatment challenge. this is the first multi-center large study revieweing SRS for this indication.

    Learning Objectives: To review the outcomes following stereotactic radiosurgery (SRS) of bAVMs in a multicenter study.


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