Radiosurgery for the management of cerebral arteriovenous malformations

Dale Ding, Robert M. Starke, Jason P. Sheehan

Research output: Chapter in Book/Report/Conference proceedingChapter

23 Scopus citations

Abstract

Cerebral arteriovenous malformations (AVMs) are rare, unstable vascular lesions which spontaneously rupture at a rate of approximately 2–4% annually. Stereotactic radiosurgery is a minimally invasive treatment for AVMs, with a favorable risk-to-benefit profile in most patients, with respect to obliteration, hemorrhage, and seizure control. Radiosurgery is ideally suited for small to medium-sized AVMs (diameter < 3 cm or volume < 12 cm3) located in deep or eloquent brain regions. Obliteration is ultimately achieved in 70–80% of cases and is directly associated with nidus volume and radiosurgical margin dose. Adverse radiation effects, which appear as T2-weighted hyperintensities on magnetic resonance imaging, develop in 30–40% of patients after AVM radiosurgery, are symptomatic in 10%, and fail to clinically resolve in 2–3%. The risk of AVM hemorrhage may be reduced by radiosurgery, but the hemorrhage risk persists during the latency period between treatment and obliteration. Delayed postradiosurgery cyst formation occurs in 2% of cases and may require surgical treatment. Radiosurgery abolishes or ameliorates seizure activity in the majority of patients with AVM-associated epilepsy and induces de novo seizures in 1–2% of those without preoperative seizures. Strategies for the treatment of large-volume AVMs include neoadjuvant embolization and either dose- or volume-staged radiosurgery.

Original languageEnglish (US)
Title of host publicationHandbook of Clinical Neurology
PublisherElsevier B.V.
Pages69-83
Number of pages15
DOIs
StatePublished - 2017
Externally publishedYes

Publication series

NameHandbook of Clinical Neurology
Volume143
ISSN (Print)0072-9752
ISSN (Electronic)2212-4152

Keywords

  • embolization
  • gamma knife
  • intracranial arteriovenous malformation
  • intracranial hemorrhage
  • microsurgery
  • obliteration
  • radiosurgery
  • seizure
  • stroke
  • vascular malformation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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