Long-term complications after gamma knife surgery for arteriovenous malformations

Masahiro Izawa Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Motohiro Hayashi Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Mikhail Chernov Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Koutarou Nakaya Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Taku Ochiai Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Noriko Murata Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Yuichi Takasu Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Osami Kubo Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Tomokatsu Hori Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Kintomo Takakura Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

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Page Range:
34–37
Volume/Issue:
Volume 102: Issue Special_Supplement
DOI link:
https://doi.org/10.3171/sup.2005.102.s_supplement.0034
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Object. The authors analyzed of the long-term complications that occur 2 or more years after gamma knife surgery (GKS) for intracranial arteriovenous malformations (AVMs).

Methods. Patients with previously untreated intracranial AVMs that were managed by GKS and followed for at least 2 years after treatment were selected for analysis (237 cases). Complete AVM obliteration was attained in 130 cases (54.9%), and incomplete obliteration in 107 cases (45.1%). Long-term complications were observed in 22 patients (9.3%). These complications included hemorrhage (eight cases), delayed cyst formation (eight cases), increase of seizure frequency (four cases), and middle cerebral artery stenosis and increased white matter signal intensity on T2-weighted magnetic resonance imaging (one case of each). The long-term complications were associated with larger nidus volume (p < 0.001) and a lobar location of the AVM (p < 0.01). Delayed hemorrhage was associated only with incomplete obliteration of the nidus (p < 0.05). Partial obliteration conveyed no benefit. Delayed cyst formation was associated with a higher maximal GKS dose (p < 0.001), larger nidus volume (p < 0.001), complete nidus obliteration (p < 0.01), and a lobar location of the AVM (p < 0.05).

Conclusions. Incomplete obliteration of the nidus is the most important factor associated with delayed hemorrhagic complications. Partial obliteration does not seem to reduce the risk of hemorrhage. Complete obliteration can be complicated by delayed cyst formation, especially if high maximal treatment doses have been administered.

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Contributor Notes

Address reprint requests to: Masahiro Izawa, M.D., Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8–1 Kawada-cho, Shinjuku-ku, Tokyo, 162–8666, Japan. email:mizawa@nij.twmu,ac.jp.
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