Evaluation of long-term radiation effect in patients with cerebral arteriovenous malformation treated using stereotactic radiosurgery.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41349035.
- Also identified by DOI 10.3171/2025.7.JNS25364.
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Abstract
For more than 4 decades, stereotactic radiosurgery (SRS) has been a standard procedure for brain arteriovenous malformation (AVM). Nonetheless, this procedure has been implicated in postobliteration intracranial hemorrhage (ICH) and delayed cyst formation (DCF). In this study, the authors investigated the long-term outcomes of SRS treatment for AVM. Authors of this retrospective study reviewed the medical records of all patients who underwent SRS for brain AVM at a single academic medical center between January 1995 and October 2014 and whose clinical follow-up was at least 5 years. Analysis focused on clinicodemographic profiles, treatment parameters, and imaging phenotypes. The final study cohort consisted of 380 patients with a mean age of 34.2 years and mean follow-up of 11.5 years. There was a slight preponderance of males in the cohort (201:179). A total of 154 patients (40.5%) experienced ICH prior to SRS treatment. The mean maximum AVM diameter was 3.3 cm, and most malformations were supratentorial (n = 325, 85.5%). Stratification based on Spetzler-Martin grade was as follows: grade I, 35 cases (9.2%); grade II, 104 cases (27.4%); grade III, 136 cases (35.8%); grade IV, 83 cases (21.8%); and grade V, 22 cases (5.8%). The median interval between SRS and complete AVM obliteration was 48.4 months. Chronic encapsulated intracerebral hematoma (CEIH) was noted in 16 patients (mean latency 14.6 years after SRS), and DCF was noted in 24 patients (mean latency 9.6 years after SRS). Among these 40 patients, 14 (35.0%) required craniotomy and 3 (7.5%) required stereotactic aspiration due to symptomatic mass effect. An analysis of risk factors revealed early radiation-induced change (RIC), infratentorial location, and prior hemorrhage as predictive of CEIH. Early RIC alone was predictive of DCF. Even after angiographic obliteration, long-term clinical and radiological surveillance is warranted due to the risk of CEIH (2.1%) and delayed cysts (3.2%) more than a decade after SRS.