• Georgios Mantziaris, Stylianos Pikis, Chloe Dumot, Sam Dayawansa, Roman Liscak, Jaromir May, Cheng-Chia Lee, Huai-Che Yang, Martínez MorenoNuriaN6Radiosurgery Unit, Hospital Ruber Internacional, Madrid, Spain., Roberto Martinez Álvarez, L Dade Lunsford, Ajay Niranjan, Zhishuo Wei, Priyanka Srinivasan, Lilly W Tang, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdel Karim, El-ShehabyAmr M NAMN8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.10Neurosurgery Department and., Reem M Emad Eldin, Ahmed Hesham Elazzazi, Selcuk Peker, Yavuz Samanci, Varun Padmanaban, Francis J Jareczek, James McInerney, Kevin M Cockroft, David Mathieu, Salman Aldakhil, Juan Diego Alzate, Douglas Kondziolka, Manjul Tripathi, Joshua D Palmer, Rituraj Upadhyay, Michelle Lin, Gabriel Zada, Cheng Yu, Christopher P Cifarelli, Daniel T Cifarelli, Ahmed Shaaban, Zhiyuan Xu, and Jason P Sheehan.
• 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
• J. Neurosurg. 2024 Jun 1; 140 (6): 175317611753-1761.

ObjectivePatients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes.MethodsThis retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose.ResultsAfter matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference -18%, 95% CI -30.9 to -5.8%, p = 0.004) and AVM obliteration (probability difference -18%, 95% CI -30.1% to -6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI -2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI -10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047).ConclusionsAVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.

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