Do the morphological characteristics of arteriovenous malformations affect the results of radiosurgery?

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  • 1 Department of Neurosurgery, University of Miami, Miami, Florida; Center for Epidemiology and Biostatistics, University of Texas, San Antonio, Texas; and Department of Neurosurgery, University of Florida, Gainesville, Florida
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Object. The authors sought to determine which morphological features of arteriovenous malformations (AVMs) are statistically predictive of preradiosurgical hemorrhage, postradiosurgical hemorrhage, and neuroimaging-defined failure of radiosurgical treatment. In addition, correlation between computerized tomography (CT) scanning and angiography for the identification of AVM structures was investigated.

Methods. Archived CT dosimetry and available angiographic and clinical data for 268 patients in whom AVMs were treated with linear accelerator radiosurgery were retrospectively reviewed. Many of the morphological features of AVMs, including location, volume, compact or diffuse nidus, neovascularity, ease of nidus identification, number of feeding arteries, location (deep or superficial) of feeding arteries, number of draining veins, deep or superficial venous drainage, venous stenoses, venous ectasias, and the presence of intranidal aneurysms, were analyzed. In addition, a number of patient and treatment factors, including patient age, presenting symptoms, radiation dose, repeated treatment, and radiological outcome, were subjected to multivariate analyses.

Two hundred twenty-seven patients were treated with radiosurgery for the first time and 41 patients underwent repeated radiosurgery. Eighty-one patients presented with a history of AVM hemorrhage and 91 patients had AVMs in a periventricular location. Twenty-six patients (10%) experienced a hemorrhage following radiosurgery. Of the 268 patients, 81 (30%) experienced angiographically defined cures, and 37 (14%) experienced MR imaging-defined cures. Eighty-six patients (32%) experienced neuroimaging-defined treatment failure, and 64 underwent insufficiently long follow up.

A larger AVM volume (odds ratio [OR] 0.349; p = 0.004) was associated with a decreased rate of pretreatment hemorrhage, whereas periventricular location (OR 6.358; p = 0.000) was associated with an increased rate of pretreatment hemorrhage. None of the analyzed factors was predictive of hemorrhage following radiosurgery. A higher radiosurgical dose was strongly correlated with neuroimaging-defined success (OR 3.743; p = 0.006), whereas a diffuse nidus structure (OR 0.246; p = 0.008) and associated neovascularity (OR 0.428; p = 0.048) were each associated with a lower neuroimaging-defined cure rate. A strong correlation between CT scanning and angiography was noted for both nidus structure (p = 0.000; Fisher exact test) and neovascularity (p = 0.002; Fisher exact test).

Conclusions. Patients presenting with AVMs that are small or periventricular were at higher risk for experiencing hemorrhage. A higher radiosurgical dose correlated strongly with neuroimaging-defined success. Patients in whom the AVM had a diffuse structure or associated neovascularity were at higher risk for neuroimaging-defined failure of radiosurgery. A strong correlation between CT scanning and angiography in the assessment of AVM structure was demonstrated.

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Contributor Notes

Address reprint requests to: William A. Friedman, M.D., P.O. Box 100265, UFBI, Department of Neurosurgery, University of Florida, Gainesville, Florida 32610. email: friedman@neurosurgery.ufl.edu.
  • 1.

    Albert P, , Salgado H, & Polaina M, et al: A study on the venous drainage of 150 cerebral arteriovenous malformations as related to haemorrhagic risks and size of the lesion. Acta Neurochir 103:3034, 1990 Albert P, Salgado H, Polaina M, et al: A study on the venous drainage of 150 cerebral arteriovenous malformations as related to haemorrhagic risks and size of the lesion. Acta Neurochir 103:30–34, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Altschuler EM, , Lunsford LD, & Coffey RJ, et al: Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 15:5361, 1989 Altschuler EM, Lunsford LD, Coffey RJ, et al: Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 15:53–61, 1989

    • Search Google Scholar
    • Export Citation
  • 3.

    Batjer H, & Samson D: Arteriovenous malformations of the posterior fossa. Clinical presentation, diagnostic evaluation, and surgical treatment. J Neurosurg 64:849856, 1986 Batjer H, Samson D: Arteriovenous malformations of the posterior fossa. Clinical presentation, diagnostic evaluation, and surgical treatment. J Neurosurg 64:849–856, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Blatt DR, , Friedman WA, & Bova FJ: Modifications based on computed tomographic imaging in planning the radiosurgical treatment of arteriovenous malformations. Neurosurgery 33:588596, 1993 Blatt DR, Friedman WA, Bova FJ: Modifications based on computed tomographic imaging in planning the radiosurgical treatment of arteriovenous malformations. Neurosurgery 33:588–596, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Bova FJ, & Friedman WA: Stereotactic angiography: an inadequate database for radiosurgery? Int J Radiat Oncol Biol Phys 20:891895, 1991 Bova FJ, Friedman WA: Stereotactic angiography: an inadequate database for radiosurgery? Int J Radiat Oncol Biol Phys 20:891–895, 1991

    • Search Google Scholar
    • Export Citation
  • 6.

    Brown RD Jr, , Wiebers DO, & Forbes G, et al: The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352357, 1988 Brown RD Jr, Wiebers DO, Forbes G, et al: The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352–357, 1988

    • Search Google Scholar
    • Export Citation
  • 7.

    Chang JH, , Chang JW, & Park YG, et al: Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 93 (Suppl 3):96101, 2000 Chang JH, Chang JW, Park YG, et al: Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 93 (Suppl 3):96–101, 2000

    • Search Google Scholar
    • Export Citation
  • 8.

    Coffey RJ, , Lunsford LD, & Bissonette D, et al: Stereotactic gamma radiosurgery for intracranial vascular malformations and tumors: report of the initial North American experience in 331 patients. Stereotact Funct Neurosurg 54/55:535540, 1990 Coffey RJ, Lunsford LD, Bissonette D, et al: Stereotactic gamma radiosurgery for intracranial vascular malformations and tumors: report of the initial North American experience in 331 patients. Stereotact Funct Neurosurg 54/55:535–540, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Coffey RJ, , Nichols DA, & Shaw EG: Stereotactic radiosurgical treatment of cerebral arteriovenous malformations. Gamma Unit Radiosurgery Study Group. Mayo Clin Proc 70:214222, 1995 Coffey RJ, Nichols DA, Shaw EG: Stereotactic radiosurgical treatment of cerebral arteriovenous malformations. Gamma Unit Radiosurgery Study Group. Mayo Clin Proc 70:214–222, 1995

    • Search Google Scholar
    • Export Citation
  • 10.

    Colombo F, , Benedetti A, & Casentini L, et al: Linear accelerator radiosurgery of arteriovenous malformations. Appl Neurophysiol 50:257261, 1987 Colombo F, Benedetti A, Casentini L, et al: Linear accelerator radiosurgery of arteriovenous malformations. Appl Neurophysiol 50:257–261, 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Colombo F, , Benedetti A, & Pozza F, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833840, 1989 Colombo F, Benedetti A, Pozza F, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833–840, 1989

    • Search Google Scholar
    • Export Citation
  • 12.

    Crawford PM, , West CR, & Chadwick DW, et al: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:110, 1986 Crawford PM, West CR, Chadwick DW, et al: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:1–10, 1986

    • Search Google Scholar
    • Export Citation
  • 13.

    Croft MJ: Stereotactic radiosurgery of arteriovenous malformations. Radiol Technol 61:375379, 1990 Croft MJ: Stereotactic radiosurgery of arteriovenous malformations. Radiol Technol 61:375–379, 1990

    • Search Google Scholar
    • Export Citation
  • 14.

    Debrun G: Measuring intraaneurysmal flow: risk of perforation. AJNR 18:1392, 1997 (Letter) Debrun G: Measuring intraaneurysmal flow: risk of perforation. AJNR 18:1392, 1997 (Letter)

    • Search Google Scholar
    • Export Citation
  • 15.

    Duma CM, , Lunsford LD, & Kondziolka D, et al: Radiosurgery for vascular malformations of the brain stem. Acta Neurochir Suppl 58:9297, 1993 Duma CM, Lunsford LD, Kondziolka D, et al: Radiosurgery for vascular malformations of the brain stem. Acta Neurochir Suppl 58:92–97, 1993

    • Search Google Scholar
    • Export Citation
  • 16.

    Duong DH, , Young WL, & Vang MC, et al: Feeding artery pressure and venous drainage pattern are primary determinants of hemorrhage from cerebral arteriovenous malformations. Stroke 29:11671176, 1998 Duong DH, Young WL, Vang MC, et al: Feeding artery pressure and venous drainage pattern are primary determinants of hemorrhage from cerebral arteriovenous malformations. Stroke 29:1167–1176, 1998

    • Search Google Scholar
    • Export Citation
  • 17.

    Ellis TL, , Friedman WA, & Bova FJ, et al: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104110, 1998 Ellis TL, Friedman WA, Bova FJ, et al: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104–110, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Fabrikant JI, , Levy RP, & Steinberg GK, et al: Charged-particle radiosurgery for intracranial vascular malformations. Neurosurg Clin N Am 3:99139, 1992 Fabrikant JI, Levy RP, Steinberg GK, et al: Charged-particle radiosurgery for intracranial vascular malformations. Neurosurg Clin N Am 3:99–139, 1992

    • Search Google Scholar
    • Export Citation
  • 19.

    Fabrikant JI, , Lyman JT, & Frankel KA: Heavy charged-particle Bragg peak radiosurgery for intracranial vascular disorders. Radiat Res Suppl 8:S244S258, 1985 Fabrikant JI, Lyman JT, Frankel KA: Heavy charged-particle Bragg peak radiosurgery for intracranial vascular disorders. Radiat Res Suppl 8:S244–S258, 1985

    • Search Google Scholar
    • Export Citation
  • 20.

    Fabrikant JI, , Lyman JT, & Hosobuchi Y: Stereotactic heavy-ion Bragg peak radiosurgery for intra-cranial vascular disorders: method for treatment of deep arteriovenous malformations. Br J Radiol 57:479490, 1984 Fabrikant JI, Lyman JT, Hosobuchi Y: Stereotactic heavy-ion Bragg peak radiosurgery for intra-cranial vascular disorders: method for treatment of deep arteriovenous malformations. Br J Radiol 57:479–490, 1984

    • Search Google Scholar
    • Export Citation
  • 21.

    Flickinger JC, , Kondziolka D, & Maitz AH, et al: An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiother Oncol 63:347354, 2002 Flickinger JC, Kondziolka D, Maitz AH, et al: An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiother Oncol 63:347–354, 2002

    • Search Google Scholar
    • Export Citation
  • 22.

    Flickinger JC, , Pollock BE, & Kondziolka D, et al: A dose-response analysis of arteriovenous malformation obliteration after radiosurgery. Int J Radiat Oncol Biol Phys 36:873879, 1996 Flickinger JC, Pollock BE, Kondziolka D, et al: A dose-response analysis of arteriovenous malformation obliteration after radiosurgery. Int J Radiat Oncol Biol Phys 36:873–879, 1996

    • Search Google Scholar
    • Export Citation
  • 23.

    Forster DM, , Steiner L, & Hakanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:562570, 1972 Forster DM, Steiner L, Hakanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:562–570, 1972

    • Search Google Scholar
    • Export Citation
  • 24.

    Friedman WA, , Blatt DL, & Bova FJ, et al: The risk of hemorrhage after radiosurgery for arteriovenous malformations. J Neurosurg 84:912919, 1996 Friedman WA, Blatt DL, Bova FJ, et al: The risk of hemorrhage after radiosurgery for arteriovenous malformations. J Neurosurg 84:912–919, 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Friedman WA, & Bova FJ: Linear accelerator radiosurgery for arteriovenous malformations. J Neurosurg 77:832841, 1992 Friedman WA, Bova FJ: Linear accelerator radiosurgery for arteriovenous malformations. J Neurosurg 77:832–841, 1992

    • Search Google Scholar
    • Export Citation
  • 26.

    Friedman WA, & Bova FJ: Radiosurgery for arteriovenous malformations. Clin Neurosurg 40:446464, 1993 Friedman WA, Bova FJ: Radiosurgery for arteriovenous malformations. Clin Neurosurg 40:446–464, 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Friedman WA, & Bova FJ: The University of Florida radiosurgery system. Surg Neurol 32:334342, 1989 Friedman WA, Bova FJ: The University of Florida radiosurgery system. Surg Neurol 32:334–342, 1989

    • Search Google Scholar
    • Export Citation
  • 28.

    Friedman WA, , Bova FJ, & Bollampally S, et al: Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery 52:296308, 2003 Friedman WA, Bova FJ, Bollampally S, et al: Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery 52:296–308, 2003

    • Search Google Scholar
    • Export Citation
  • 29.

    Friedman WA, , Bova FJ, & Mendenhall WM: Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. J Neurosurg 82:180189, 1995 Friedman WA, Bova FJ, Mendenhall WM: Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. J Neurosurg 82:180–189, 1995

    • Search Google Scholar
    • Export Citation
  • 30.

    Fults D, & Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658662, 1984 Fults D, Kelly DL Jr: Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–662, 1984

    • Search Google Scholar
    • Export Citation
  • 31.

    Gallina P, , Merienne L, & Meder JF, et al: Failure in radiosurgery treatment of cerebral arteriovenous malformations. Neurosurgery 42:9961004, 1998 Gallina P, Merienne L, Meder JF, et al: Failure in radiosurgery treatment of cerebral arteriovenous malformations. Neurosurgery 42:996–1004, 1998

    • Search Google Scholar
    • Export Citation
  • 32.

    Graf CJ, , Perret GE, & Torner JC: Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331337, 1983 Graf CJ, Perret GE, Torner JC: Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331–337, 1983

    • Search Google Scholar
    • Export Citation
  • 33.

    Griffin BR, , Warcola SH, & Mayberg MR, et al: Stereotactic neutron radiosurgery for arteriovenous malformations of the brain. Med Dosim 13:179182, 1988 Griffin BR, Warcola SH, Mayberg MR, et al: Stereotactic neutron radiosurgery for arteriovenous malformations of the brain. Med Dosim 13:179–182, 1988

    • Search Google Scholar
    • Export Citation
  • 34.

    Guidetti B, & Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149152, 1980 Guidetti B, Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149–152, 1980

    • Search Google Scholar
    • Export Citation
  • 35.

    Hademenos GJ, & Massoud TF: Risk of intracranial arteriovenous malformation rupture due to venous drainage impairment. A theoretical analysis. Stroke 27:10721083, 1996 Hademenos GJ, Massoud TF: Risk of intracranial arteriovenous malformation rupture due to venous drainage impairment. A theoretical analysis. Stroke 27:1072–1083, 1996

    • Search Google Scholar
    • Export Citation
  • 36.

    Hadjipanayis CG, , Levy EI, & Niranjan A, et al: Stereotactic radiosurgery for motor cortex region arteriovenous malformations. Neurosurgery 48:7077, 2001 Hadjipanayis CG, Levy EI, Niranjan A, et al: Stereotactic radiosurgery for motor cortex region arteriovenous malformations. Neurosurgery 48:70–77, 2001

    • Search Google Scholar
    • Export Citation
  • 37.

    Halim AX, , Singh V, & Johnston SC, et al: Characteristics of brain arteriovenous malformations with coexisting aneurysms: a comparison of two referral centers. Stroke 33:675679, 2002 Halim AX, Singh V, Johnston SC, et al: Characteristics of brain arteriovenous malformations with coexisting aneurysms: a comparison of two referral centers. Stroke 33:675–679, 2002

    • Search Google Scholar
    • Export Citation
  • 38.

    Hosobuchi Y, , Fabricant J, & Lyman J: Stereotactic heavy-particle irradiation of intracranial arteriovenous malformations. Appl Neurophysiol 50:248252, 1987 Hosobuchi Y, Fabricant J, Lyman J: Stereotactic heavy-particle irradiation of intracranial arteriovenous malformations. Appl Neurophysiol 50:248–252, 1987

    • Search Google Scholar
    • Export Citation
  • 39.

    Itoyama Y, , Uemura S, & Ushio Y, et al: Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases. J Neurosurg 71:805809, 1989 Itoyama Y, Uemura S, Ushio Y, et al: Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases. J Neurosurg 71:805–809, 1989

    • Search Google Scholar
    • Export Citation
  • 40.

    Kader A, , Young WL, & Pile-Spellman J, et al: The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. Neurosurgery 34:801808, 1994 Kader A, Young WL, Pile-Spellman J, et al: The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. Neurosurgery 34:801–808, 1994

    • Search Google Scholar
    • Export Citation
  • 41.

    Karlsson B, , Lax I, & Soderman M: Can the probability for obliteration after radiosurgery for arteriovenous malformations be accurately predicted? Int J Radiat Oncol Biol Phys 43:313319, 1999 Karlsson B, Lax I, Soderman M: Can the probability for obliteration after radiosurgery for arteriovenous malformations be accurately predicted? Int J Radiat Oncol Biol Phys 43:313–319, 1999

    • Search Google Scholar
    • Export Citation
  • 42.

    Karlsson B, , Lax I, & Soderman M: Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 49:10451051, 2001 Karlsson B, Lax I, Soderman M: Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 49:1045–1051, 2001

    • Search Google Scholar
    • Export Citation
  • 43.

    Karlsson B, , Lindquist C, & Steiner L: Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425431, 1997 Karlsson B, Lindquist C, Steiner L: Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425–431, 1997

    • Search Google Scholar
    • Export Citation
  • 44.

    Kemeny AA, , Dias PS, & Forster DM: Results of stereotactic radiosurgery of arteriovenous malformations: an analysis of 52 cases. J Neurol Neurosurg Psychiatry 52:554558, 1989 Kemeny AA, Dias PS, Forster DM: Results of stereotactic radiosurgery of arteriovenous malformations: an analysis of 52 cases. J Neurol Neurosurg Psychiatry 52:554–558, 1989

    • Search Google Scholar
    • Export Citation
  • 45.

    Kjellberg RN: Stereotactic Bragg peak proton beam radiosurgery for cerebral arteriovenous malformations. Ann Clin Res 18 (Suppl 47):1719, 1986 Kjellberg RN: Stereotactic Bragg peak proton beam radiosurgery for cerebral arteriovenous malformations. Ann Clin Res 18 (Suppl 47):17–19, 1986

    • Search Google Scholar
    • Export Citation
  • 46.

    Kjellberg RN, , Hanamura T, & Davis KR, et al: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269274, 1983 Kjellberg RN, Hanamura T, Davis KR, et al: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269–274, 1983

    • Search Google Scholar
    • Export Citation
  • 47.

    Kondziolka D, , Lunsford LD, & Kanal E, et al: Stereotactic magnetic resonance angiography for targeting in arteriovenous malformation radiosurgery. Neurosurgery 35:585591, 1994 Kondziolka D, Lunsford LD, Kanal E, et al: Stereotactic magnetic resonance angiography for targeting in arteriovenous malformation radiosurgery. Neurosurgery 35:585–591, 1994

    • Search Google Scholar
    • Export Citation
  • 48.

    Kurita H, , Kawamoto S, & Sasaki T, et al: Results of radiosurgery for brain stem arteriovenous malformations. J Neurol Neurosurg Psychiatry 68:563570, 2000 Kurita H, Kawamoto S, Sasaki T, et al: Results of radiosurgery for brain stem arteriovenous malformations. J Neurol Neurosurg Psychiatry 68:563–570, 2000

    • Search Google Scholar
    • Export Citation
  • 49.

    Langer DJ, , Lasner TM, & Hurst RW, et al: Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations. Neurosurgery 42:481489, 1998 Langer DJ, Lasner TM, Hurst RW, et al: Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations. Neurosurgery 42:481–489, 1998

    • Search Google Scholar
    • Export Citation
  • 50.

    Levy EI, , Niranjan A, & Thompson TP, et al: Radiosurgery for childhood intracranial arteriovenous malformations. Neurosurgery 47:834842, 2000 Levy EI, Niranjan A, Thompson TP, et al: Radiosurgery for childhood intracranial arteriovenous malformations. Neurosurgery 47:834–842, 2000

    • Search Google Scholar
    • Export Citation
  • 51.

    Levy RP, , Fabrikant JI, & Frankel KA, et al: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841852, 1989 Levy RP, Fabrikant JI, Frankel KA, et al: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841–852, 1989

    • Search Google Scholar
    • Export Citation
  • 52.

    Lindqvist M, , Karlsson B, & Guo WY, et al: Angiographic long-term follow-up data for arteriovenous malformations previously proven to be obliterated after gamma knife radiosurgery. Neurosurgery 46:803810, 2000 Lindqvist M, Karlsson B, Guo WY, et al: Angiographic long-term follow-up data for arteriovenous malformations previously proven to be obliterated after gamma knife radiosurgery. Neurosurgery 46:803–810, 2000

    • Search Google Scholar
    • Export Citation
  • 53.

    Loeffler JS, , Alexander E III, & Siddon RL, et al: Stereotactic radiosurgery for intracranial arteriovenous malformations using a standard linear accelerator. Int J Radiat Oncol Biol Phys 17:673677, 1989 Loeffler JS, Alexander E III, Siddon RL, et al: Stereotactic radiosurgery for intracranial arteriovenous malformations using a standard linear accelerator. Int J Radiat Oncol Biol Phys 17:673–677, 1989

    • Search Google Scholar
    • Export Citation
  • 54.

    Lunsford LD, , Flickinger J, & Coffey RJ: Stereotactic gamma knife radiosurgery. Initial North American experience in 207 patients. Arch Neurol 47:169175, 1990 Lunsford LD, Flickinger J, Coffey RJ: Stereotactic gamma knife radiosurgery. Initial North American experience in 207 patients. Arch Neurol 47:169–175, 1990

    • Search Google Scholar
    • Export Citation
  • 55.

    Lunsford LD, , Kondziolka D, & Flickinger JC, et al: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512524, 1991 Lunsford LD, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512–524, 1991

    • Search Google Scholar
    • Export Citation
  • 56.

    Mansmann U, , Meisel J, & Brock M, et al: Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation. Neurosurgery 46:272281, 2000 Mansmann U, Meisel J, Brock M, et al: Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation. Neurosurgery 46:272–281, 2000

    • Search Google Scholar
    • Export Citation
  • 57.

    Marks MP, , Lane B, & Steinberg GK, et al: Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. Radiology 176:807813, 1990 Marks MP, Lane B, Steinberg GK, et al: Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. Radiology 176:807–813, 1990

    • Search Google Scholar
    • Export Citation
  • 58.

    Massager N, , Regis J, & Kondziolka D, et al: Gamma knife radiosurgery for brainstem arteriovenous malformations: preliminary results. J Neurosurg 93 (Suppl 3):102103, 2000 Massager N, Regis J, Kondziolka D, et al: Gamma knife radiosurgery for brainstem arteriovenous malformations: preliminary results. J Neurosurg 93 (Suppl 3):102–103, 2000

    • Search Google Scholar
    • Export Citation
  • 59.

    Mast H, , Young WL, & Koennecke HC, et al: Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 350:10651068, 1997 Mast H, Young WL, Koennecke HC, et al: Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 350:1065–1068, 1997

    • Search Google Scholar
    • Export Citation
  • 60.

    Meder JF, , Oppenheim C, & Trystram D, et al: Radiotherapie stereo-taxique des malformations arterio-veineuses cerebrales: place de la neuroradiologie. J Neuroradiol 24:126133, 1997 Meder JF, Oppenheim C, Trystram D, et al: Radiotherapie stereo-taxique des malformations arterio-veineuses cerebrales: place de la neuroradiologie. J Neuroradiol 24:126–133, 1997

    • Search Google Scholar
    • Export Citation
  • 61.

    Miyasaka Y, , Yada K, & Ohwada T, et al: An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations. J Neurosurg 76:239243, 1992 Miyasaka Y, Yada K, Ohwada T, et al: An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations. J Neurosurg 76:239–243, 1992

    • Search Google Scholar
    • Export Citation
  • 62.

    Pan DH, , Guo WY, & Chung WY, et al: Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations. J Neurosurg 93 (Suppl 3):113119, 2000 Pan DH, Guo WY, Chung WY, et al: Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations. J Neurosurg 93 (Suppl 3):113–119, 2000

    • Search Google Scholar
    • Export Citation
  • 63.

    Pollock BE, , Flickinger JC, & Lunsford LD, et al: Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 42:12391247, 1998 Pollock BE, Flickinger JC, Lunsford LD, et al: Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 42:1239–1247, 1998

    • Search Google Scholar
    • Export Citation
  • 64.

    Pollock BE, , Flickinger JC, & Lunsford LD, et al: Factors that predict the bleeding risk of cerebral arteriovenous malformations. Stroke 27:16, 1996 Pollock BE, Flickinger JC, Lunsford LD, et al: Factors that predict the bleeding risk of cerebral arteriovenous malformations. Stroke 27:1–6, 1996

    • Search Google Scholar
    • Export Citation
  • 65.

    Pollock BE, , Flickinger JC, & Lunsford LD, et al: Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 38:652661, 1996 Pollock BE, Flickinger JC, Lunsford LD, et al: Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 38:652–661, 1996

    • Search Google Scholar
    • Export Citation
  • 66.

    Pollock BE, , Kondziolka D, & Lunsford LD, et al: Repeat stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. Neurosurgery 38:318324, 1996 Pollock BE, Kondziolka D, Lunsford LD, et al: Repeat stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. Neurosurgery 38:318–324, 1996

    • Search Google Scholar
    • Export Citation
  • 67.

    Pollock BE, , Lunsford LD, & Kondziolka D, et al: Patient outcomes after stereotactic radiosurgery for “operable” arteriovenous malformations. Neurosurgery 35:18, 1994 Pollock BE, Lunsford LD, Kondziolka D, et al: Patient outcomes after stereotactic radiosurgery for “operable” arteriovenous malformations. Neurosurgery 35:1–8, 1994

    • Search Google Scholar
    • Export Citation
  • 68.

    Saunders WM, , Winston KR, & Siddon RL, et al: Radiosurgery for arteriovenous malformations of the brain using a standard linear accelerator: rationale and technique. Int J Radiat Oncol Biol Phys 15:441447, 1988 Saunders WM, Winston KR, Siddon RL, et al: Radiosurgery for arteriovenous malformations of the brain using a standard linear accelerator: rationale and technique. Int J Radiat Oncol Biol Phys 15:441–447, 1988

    • Search Google Scholar
    • Export Citation
  • 69.

    Schlienger M, , Atlan D, & Lefkopoulos D, et al: Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients. Int J Radiat Oncol Biol Phys 46:11351142, 2000 Schlienger M, Atlan D, Lefkopoulos D, et al: Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients. Int J Radiat Oncol Biol Phys 46:1135–1142, 2000

    • Search Google Scholar
    • Export Citation
  • 70.

    Seifert V, , Stolke D, & Mehdorn HM, et al: Clinical and radiological evaluation of long-term results of stereotactic proton beam radiosurgery in patients with cerebral arteriovenous malformations. J Neurosurg 81:683689, 1994 Seifert V, Stolke D, Mehdorn HM, et al: Clinical and radiological evaluation of long-term results of stereotactic proton beam radiosurgery in patients with cerebral arteriovenous malformations. J Neurosurg 81:683–689, 1994

    • Search Google Scholar
    • Export Citation
  • 71.

    Souhami L, , Olivier A, & Podgorsak EB, et al: Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 19:775782, 1990 Souhami L, Olivier A, Podgorsak EB, et al: Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 19:775–782, 1990

    • Search Google Scholar
    • Export Citation
  • 72.

    Spetzler RF, , Hargraves RW, & McCormick PW, et al: Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations. J Neurosurg 76:918923, 1992 Spetzler RF, Hargraves RW, McCormick PW, et al: Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations. J Neurosurg 76:918–923, 1992

    • Search Google Scholar
    • Export Citation
  • 73.

    Spetzler RF, & Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476483, 1986 Spetzler RF, Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986

    • Search Google Scholar
    • Export Citation
  • 74.

    Spiegelmann R, , Friedman WA, & Bova FJ: Limitations of angiographic target localization in planning radiosurgical treatment. Neurosurgery 30:619624, 1992 Spiegelmann R, Friedman WA, Bova FJ: Limitations of angiographic target localization in planning radiosurgical treatment. Neurosurgery 30:619–624, 1992

    • Search Google Scholar
    • Export Citation
  • 75.

    Stefani MA, , Porter PJ, & terBrugge KG, et al: Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presentation. Stroke 33:920924, 2002 Stefani MA, Porter PJ, terBrugge KG, et al: Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presentation. Stroke 33:920–924, 2002

    • Search Google Scholar
    • Export Citation
  • 76.

    Stelzer K, , Griffin B, & Eskridge J, et al: Results of neutron radiosurgery for inoperable arteriovenous malformations of the brain. Med Dosim 16:137141, 1991 Stelzer K, Griffin B, Eskridge J, et al: Results of neutron radiosurgery for inoperable arteriovenous malformations of the brain. Med Dosim 16:137–141, 1991

    • Search Google Scholar
    • Export Citation
  • 77.

    Touboul E, , Al Halabi A, & Buffat L, et al: Single-fraction stereotactic radiotherapy: a dose-response analysis of arteriovenous malformation obliteration. Int J Radiat Oncol Biol Phys 41:855861, 1998 Touboul E, Al Halabi A, Buffat L, et al: Single-fraction stereotactic radiotherapy: a dose-response analysis of arteriovenous malformation obliteration. Int J Radiat Oncol Biol Phys 41:855–861, 1998

    • Search Google Scholar
    • Export Citation
  • 78.

    Turjman F, , Massoud TF, & Viñuela F, et al: Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage. Neurosurgery 37:856862, 1995 Turjman F, Massoud TF, Viñuela F, et al: Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage. Neurosurgery 37:856–862, 1995

    • Search Google Scholar
    • Export Citation
  • 79.

    Valentino V: Radiosurgery in cerebral tumors and AVM. Acta Neurochir Suppl 42:193197, 1988 Valentino V: Radiosurgery in cerebral tumors and AVM. Acta Neurochir Suppl 42:193–197, 1988

    • Search Google Scholar
    • Export Citation
  • 80.

    Willinsky R, , Lasjaunias P, & Terbrugge K, et al: Brain arteriovenous malformations: analysis of the angio-architecture in relationship to hemorrhage (based on 152 patients explored and/or treated at the hopital de Bicetre between 1981 and 1986). J Neuroradiol 15:225237, 1988 Willinsky R, Lasjaunias P, Terbrugge K, et al: Brain arteriovenous malformations: analysis of the angio-architecture in relationship to hemorrhage (based on 152 patients explored and/or treated at the hopital de Bicetre between 1981 and 1986). J Neuroradiol 15:225–237, 1988

    • Search Google Scholar
    • Export Citation
  • 81.

    Yamamoto M, , Jimbo M, & Hara M, et al: Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery 38:906914, 1996 Yamamoto M, Jimbo M, Hara M, et al: Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery 38:906–914, 1996

    • Search Google Scholar
    • Export Citation
  • 82.

    Young C, , Summerfield R, & Schwartz M, et al: Radiosurgery for arteriovenous malformations: the University of Toronto experience. Can J Neurol Sci 24:99105, 1997 Young C, Summerfield R, Schwartz M, et al: Radiosurgery for arteriovenous malformations: the University of Toronto experience. Can J Neurol Sci 24:99–105, 1997

    • Search Google Scholar
    • Export Citation
  • 83.

    Young CS, , Schwartz ML, & O'Brien P, et al: Stereotactic radiotherapy for AVMs: the University of Toronto experience. Acta Neurochir Suppl 63:5759, 1995 Young CS, Schwartz ML, O'Brien P, et al: Stereotactic radiotherapy for AVMs: the University of Toronto experience. Acta Neurochir Suppl 63:57–59, 1995

    • Search Google Scholar
    • Export Citation

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