A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery

Int J Radiat Oncol Biol Phys. 1999 Apr 1;44(1):67-74. doi: 10.1016/s0360-3016(98)00518-5.


Purpose: To better understand radiation complications of arteriovenous malformation (AVM) radiosurgery and factors affecting their resolution.

Methods and materials: AVM patients (102/1255) who developed neurological sequelae after radiosurgery were studied. The median AVM marginal dose (Dmin) was 19 Gy (range: 10-35). The median volume was 5.7 cc (range: 0.26-143). Median follow-up was 34 months (range: 9-140).

Results: Complications consisted of 80/102 patients with evidence of radiation injury to the brain parenchyma (7 also with cranial nerve deficits, 12 also with seizures, 5 with cyst formation), 12/102 patients with isolated cranial neuropathies, and 10/102 patients with only new or worsened seizures. Severity was classified as minimal in 39 patients, mild in 40, disabling in 21, and fatal in 2 patients. Symptoms resolved completely in 42 patients for an actuarial resolution rate of 54% +/- 7% at 3 years post-onset. Multivariate analysis identified significantly greater symptom resolution in patients with no prior history of hemorrhage (p = 0.01, 66% vs. 41%), and in patients with symptoms of minimal severity: headache or seizure as the only sequelae of radiosurgery (p < 0.0001, 88% vs. 34%).

Conclusion: Late sequelae of radiosurgery manifest in varied ways. Further long-term studies of these problems are needed that take into account symptom severity and prior hemorrhage history.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Analysis of Variance
  • Brain / drug effects
  • Brain / radiation effects*
  • Brain Diseases / etiology
  • Cranial Nerve Diseases / etiology
  • Cysts / etiology
  • Humans
  • Intracranial Arteriovenous Malformations / surgery*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Radiation Injuries / complications*
  • Radiation Injuries / drug therapy
  • Radiosurgery / adverse effects*
  • Radiotherapy Dosage
  • Seizures / etiology
  • Severity of Illness Index


  • Adrenal Cortex Hormones