LINAC Radiosurgery of Intracranial Arteriovenous Malformations: A Single-center Initial Experience

Background: The desired goal for treatment of cerebral arteriovenous malformations (AVMs) is complete removal or obliteration of the nidus without complications. The contemporary management includes microsurgery, endovascular embolization, and stereotactic radiosurgery, in a single or a multimodal way. This study shows the initial results of linear accelerator (Linac)-based stereotactic radiosurgery for patients with intracranial AVMs treated at Alexandria Radiosurgery Center. Methods: The study included 13 patients (10 male and 3 female) with a mean age of 26 years (range; 13 to 43 y) having AVMs in various locations in brain. Linac radiosurgery was performed on target volumes averaging 4.5 cm(3) (range, 1.4 to 12.5; median, 3.5), which received an average radiation dose of 18.8Gy (range, 12 to 26; median, 18) prescribed to the average isodose line of 80%. Clinical and radiologic follow-up periods were a minimum of 2 to 3 years after radiosurgical treatment. Results: Magnetic resonance imaging, evidence of postradiosurgical complete obliteration or reduction in volume of the AVM nidus, was obtained in 11 (85%) of the 13 patients. Two (15.5%) of the 13 AVMs had no change in the volume of their nidus. The overall rate of angiographically documented complete obliteration of AVM nidus was 54%. The overall radiosurgery-related morbidity and mortality were 30% and 0%, respectively. Conclusions: The initial results of Linac radiosurgical treatment of intracranial AVMs showed in this study compare favorably with the literature and further support the safety and efficacy of radiosurgery as a valuable treatment option for AVMs.