• Or Cohen-Inbar, Robert M Starke, Cheng-Chia Lee, Hideyuki Kano, Paul Huang, Douglas Kondziolka, Inga S Grills, Danilo Silva, Mohmoud Abbassy, Symeon Missios, Gene H Barnett, L Dade Lunsford, and Jason P Sheehan.
• Department of Neurosurgery and Gamma-Knife center, University of Virginia, Charlottesville, Virginia.
• Neurosurgery. 2017 Dec 1; 81 (6): 910-920.

BackgroundThe management of brainstem arteriovenous malformations (bAVMs) is a formidable challenge. bAVMs harbor higher morbidity and mortality compared to other locations.ObjectiveTo review the outcomes following stereotactic radiosurgery (SRS) of bAVMs in a multicenter study.MethodsSix 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.ResultsOverall 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).ConclusionSRS for bAVMs results in obliteration and avoids permanent complications in the majority of patients.Copyright © 2017 by the Congress of Neurological Surgeons

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