Optimal Radiosurgery Dosages for the Treatment of Arteriovenous Malformations in the Era of Magnetic Resonance Imaging

Long-term complications after gamma knife surgery for arteriovenous malformations

“…Radiation necrosis has been reported with a frequency 1.7 to 7.6% after GKS for AVMs. 1,4,5,11 It was not observed in any case in the present series.…”

“…7 The overall obliteration rate in the present series was 54.9%, which is lower than that usually reported (60.4-81.3%). 1,2,4,5,11 This may be related to case selection with inclusion of only previously untreated patients who did not obtain any other treatment the first 2 years after GKS. In addition this series contained a relatively high percentage of patients with high-grade AVMs, the larger size of which enforce a low prescription dose.…”

“…Target error is also known to be a possible cause of treatment failure. 1,2,4,5 It may be noted that 25.3% of cases in which partial obliteration was attained may well go on to complete obliteration at a later date. Complete obliteration of AVMs up to 60 months after GKS had been reported.…”

“…4,6 The main pitfall of the highdose GKS is the radiation-induced injury to the surrounding brain tissue especially if the target volume is large. 4,5 Recently the concept of staged radiosurgery for treatment of large AVMs had been proposed 1,8 and is now in use in our clinic. The success rate of this technique and its place in the management of AVMs awaits determination.…”

Gamma Knife®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

“…Also, concurrent cyst formation is considered to be relevant with radiation injury. It was observed in 8 patients (3.4%), and 0.4-4.0% of patients have reportedly developed the symptom [9][10][11][12][13][14][15]. With a longer follow-up, the rate increases up to 7.9-28.1% [9,11].…”