Clinical outcome of radiosurgery for cerebral arteriovenous malformations

Ladislau SteinerDepartment of Neurological Surgery, University of Virginia, Charlottesville, Virginia, and Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden

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Christer LindquistDepartment of Neurological Surgery, University of Virginia, Charlottesville, Virginia, and Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden

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John R. AdlerDepartment of Neurological Surgery, University of Virginia, Charlottesville, Virginia, and Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden

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James C. TornerDepartment of Neurological Surgery, University of Virginia, Charlottesville, Virginia, and Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden

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Wayne AlvesDepartment of Neurological Surgery, University of Virginia, Charlottesville, Virginia, and Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden

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Melita SteinerDepartment of Neurological Surgery, University of Virginia, Charlottesville, Virginia, and Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden

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Volume 77: Issue 1
DOI link:
https://doi.org/10.3171/jns.1992.77.1.0001
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✓ The clinical outcomes are described for 247 consecutive cases of arteriovenous malformation (AVM) treated with the gamma knife between April, 1970, and December 31, 1983. Headache resolved in 65 (66.3%) of the 98 patients presenting with this symptom and improved in an additional nine (9.2%). Of 59 patients admitted with seizures, 11 (18.6%) became seizure-free without anticonvulsant medication and an additional 30 patients (50.8%) became seizure-free with anticonvulsant medication. Pre-existing neurological deficits improved or totally disappeared following radiosurgery in 56.7% of affected cases. This improvement presumably occurred within the frame of the natural history.

The protective effect of the ionizing beams against hemorrhage in incompletely obliterated AVM's is analyzed. To assess the rate of rebleeding, probability estimates were calculated using both the person-year method and the Kaplan-Meier life table. With the person-year method the actual rebleed rate is not too different from the values observed in the natural history of the disease (2% to 3%/yr). Analysis by Kaplan-Meier life-table estimates demonstrated a risk of nearly 3.7%/yr until 60 months after radiosurgery. Five years following treatment, the life table ends in a plateau which could be interpreted as an indication of decrease in the risk of hemorrhage. However, long flat regions at the right end of the life table do not imply that the real risk of rebleeding is negligible unless a large number of patients have been followed well into or beyond the flat region.

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Contributor Notes

Address for Dr. Adler: Department of Neurosurgery, Stanford Medical Center, Stanford, California.
Address for Dr. Torner: Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City, Iowa.
Address reprint requests to: Ladislau Steiner, M.D., Ph.D., Department of Neurological Surgery, University of Virginia, Health Sciences Center, Box 212, Charlottesville, Virginia 22908.
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