Arteriovenous malformations treated by stereotactic radiosurgery – Review of an Australian single centre’s experience

• Published in: Journal of clinical neuroscience 2025-02, Vol.132, p.110961, Article 110961
• Main Authors: Morris, Daniel, Williams, Janet R., Vangelov, Belinda, Smee, Robert I.
• Format: Article
• Language: English
• Subjects: AVM; Linear accelerator; post-SRS complications; Stereotactic radiosurgery; Vascular obliteration rates
• ISSN: 0967-5868; 1532-2653; 1532-2653
• DOI: 10.1016/j.jocn.2024.110961

•High vascular obliteration rate in small AVMs is comparable to the literature.•Radiation-induced changes are frequent however clinical morbidity is low.•Radiosurgery dose ≥ 18 Gy is predictive of achieving obliteration.•Permanent complications more likely when > 1 Stereotactic Radiosurgery session given.•Medium volume AVMs (2–4 cm3) have shortest time to obliteration over 4 years. Linear accelerator (LINAC) stereotactic radiosurgery (SRS) is a specialised treatment used for various brain conditions, including arteriovenous malformations (AVMs). This paper investigates the obliteration rate of AVMs treated by the LINAC-based facility at Prince of Wales Hospital, defines factors influencing obliteration rate, time to obliteration and complications post-SRS. A retrospective audit review of patient notes sourced from electronic medical records was conducted. During the study period 219 patients received treatment, of which the final status of 136 AVMs was known. Overall obliteration rate was 75.7 %, with obliteration rates of 5 %, 30 % and 46 % at one, three and four years, respectively. Post analysis, a radiosurgery dose of ≥ 18 Gray (Gy) was predictive of achieving obliteration (Odds Ratio (OR) 4.2, 95 % Confidence Interval (CI) 1.61–10.83, p = 0.003) whilst a nidus size of 3–6 cm was less likely of achieving obliteration (OR 0.2, CI 0.10–0.57, p = 0.001). Multivariate analysis showed a radiosurgery dose of ≥ 18 Gy remained predictive (OR 4.7, CI 1.69–13.25, p = 0.003) and a nidus size of 3–6 cm remained less likely to achieve obliteration (OR 0.2, CI 0.10–0.57, p = 0.001). Females were predictive of developing temporary complications post-SRS in multivariate analysis (OR 2.8, CI 1.24–6.13, p = 0.013), and having > 1 SRS session was predictive of developing permanent complications post-SRS (OR 7.1, CI 2.44–20.53, p