The radiosurgical treatment of arteriovenous malformations: obliteration, morbidities, and performance status.

Objective This study examined the single-center treatment outcomes of arteriovenous malformations (AVMs) of the brain using stereotactic radiosurgery, with regard to obliteration, predictive factors, morbidities, and patient performance status. Patients and Methods 127 patients were treated between 1990 and 2008 by use of linear accelerator or Gamma Knife. Their median age was 37 years, the median AVM volume was 7.3 cc (range, 0.014–113.13 cc), and the median follow-up duration was 42 months (range, 6–209 months). Forty-two percent of patients presented with intracranial hemorrhage, 31% received embolization, and 8% underwent prior resection. Thirty-one percent of patients received more than one round of radiosurgery. Results 64% of patients had complete obliteration confirmed by magnetic resonance imaging or angiography. Positive predictors of obliteration included pretreatment hemorrhage ( p = 0.042), smaller AVM volume (odds ratio=1.25; 95% CI, 1.03–1.52), and larger marginal dose (odds ratio=0.292; 95% CI, 0.100–0.820), whereas embolization ( p p Conclusions Stereotactic radiosurgery is an effective tool in the treatment of AVMs and amelioration of AVM-related headaches, but it did not affect the patients' performance status. Factors affecting obliteration include prior hemorrhage, marginal dose, prior embolization, and AVM volume. Risk of hemorrhage persists in the latency period after radiosurgery, and it remains finite even after complete obliteration.