Treatment of arteriovenous malformations using Gamma Knife surgery: the experience at the University of Washington from 2000 to 2005

James G. Douglas Departments of Radiation Oncology,
Neurological Surgery, and
Pediatrics, University of Washington Cancer Center, Seattle, Washington

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 M.D., M.S.
and
Robert Goodkin Departments of Radiation Oncology,
Neurological Surgery, and

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Object

The purpose of this study was to examine the efficacy and toxicity of treating arteriovenous malformations (AVMs) with the model 3C Gamma Knife at the University of Washington Medical Center.

Methods

Ninety-five evaluable patients with 99 treatable AVMs were treated at the University of Washington Medical Center from April 2000 through June 2005. The median patient age at the time of treatment was 40 years (range 6–68 years). The male to female patient ratio was 0.98:1. The median AVM volume treated was 3.8 cm3 (range 0.12–32 cm3). Forty-four percent of the patients had hemorrhaged prior to treatment. The median peripheral Gamma Knife surgery dose was 20 Gy with a median of 12 isocenters treated. The median follow-up duration was 38 months (range 3–91 months). Eighty-one percent of the patients had no previous stereotactic radiosurgery (SRS), whereas the remaining 19% had previously been treated with linear accelerator–based SRS.

Results

The Kaplan–Meier estimated 6-year AVM obliteration rate for the entire cohort was 71.4%. The Kaplan–Meier estimated 6-year obliteration rate was 72% for patients having no prior SRS and 54.5% for those undergoing repeat SRS. The median time to AVM obliteration was 47 months, with 90% of the obliterations occurring between 24 and 58 months. Eight patients (7.4%) experienced late toxicities. There were 2 fatal bleeds and 13 (13.8%) nonfatal bleeds after Gamma Knife surgery.

Conclusions

Gamma Knife surgery is an effective treatment for AVMs, resulting in an excellent obliteration rate with acceptable toxicity.

Abbreviations used in this paper:

AVM = arteriovenous malformation; GKS = Gamma Knife surgery; LINAC = linear accelerator.
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