• Ho Sung Myeong, Sang Soon Jeong, Jung Hoon Kim, Jae Meen Lee, Kwang Hyon Park, Kawngwoo Park, Hyun Joo Park, Hye Ran Park, Byung Woo Yoon, Seokyung Hahn, Eun Jung Lee, Jin Wook Kim, Hyun Tai Chung, Dong Gyu Kim, and Sun Ha Paek.
• Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
• J. Korean Med. Sci. 2024 Jul 29; 39 (29): e217e217.

BackgroundTreatment for large (> 10 mL) arteriovenous malformations (AVMs) remains highly challenging. This study evaluated long-term effect of time-staged gamma knife radiosurgery (GKS) for large AVMs.MethodsFor patients with large AVMs treated by time-staged GKS over 10 years, time-staged GKS was repeated every three years targeting the entire nidus if total obliteration was not achieved. Obliteration rate and post-GKS complications were assessed based on 10 mL volume interval of AVMs. Prognostic factors for these outcomes were evaluated using Cox regression analysis.ResultsNinety-six patients were analyzed. For AVMs in the 10-20 mL subgroup, a dose ≥ 13.5Gy yielded higher obliteration rate in the first GKS. In the 20-30 mL subgroup, a second GKS significantly boosted obliteration. AVMs > 30 mL did not achieve any obliteration with the first GKS. Among 35 (36.4%) cases lost to follow-up, 7 (7.2%) were lost due to GKS complications. Kaplan-Meier analysis showed that each subgroup needed different time for achieving 50% favorable obliteration outcome rate: 3.5, 6.5, and 8.2 years for 10-20 mL, 20-30 mL, and > 30 mL subgroup, respectively. Total obliteration rate calculated by intention-to-treat method: 73%, 51.7%, 35.7%, respectively, 61.5% overall. Post-GKS hemorrhage and chronic encapsulated expanding hematoma (CEEH) occurred in 13.5% and 8.3% of cases, respectively. Two patients died. Dose and volume were significant prognostic factors for obliteration. Initial AVM volume was a significant prognostic factor of post-GKS hemorrhage and CEEH.ConclusionTime-staged GKS for large AVMs less than 30 mL has highly favorable long-term outcome and a tolerable complication rate.© 2024 The Korean Academy of Medical Sciences.

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