Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group

Int J Radiat Oncol Biol Phys. 2000 Mar 15;46(5):1143-8. doi: 10.1016/s0360-3016(99)00513-1.


Purpose: To better predict permanent complications from arteriovenous malformation (AVM) radiosurgery.

Methods and materials: Data from 85 AVM patients who developed symptomatic complications following gamma knife radiosurgery and 337 control patients with no complications were evaluated as part of a multi-institutional study. Of the 85 patients with complications, 38 patients were classified as having permanent symptomatic sequelae (necrosis). AVM marginal doses varied from 10-35 Gy and treatment volumes from 0.26-47.9 cc. Median follow-up for patients without complications was 45 months (range: 24-92).

Results: Multivariate analysis of the effects of AVM location and the volume of tissue receiving 12 Gy or more (12-Gy-Volume) allowed construction of a significant postradiosurgery injury expression (SPIE) score. AVM locations in order of increasing risk and SPIE score (from 0-10) were: frontal, temporal, intraventricular, parietal, cerebellar, corpus callosum, occipital, medulla, thalamus, basal ganglia, and pons/midbrain. The final statistical model predicts risks of permanent symptomatic sequelae from SPIE scores and 12-Gy-Volumes. Prior hemorrhage, marginal dose, and Marginal-12-Gy-Volume (target volume excluded) did not significantly improve the risk-prediction model for permanent sequelae (p >/= 0.39).

Conclusion: The risks of developing permanent symptomatic sequelae from AVM radiosurgery vary dramatically with location and, to a lesser extent, volume. These risks can be predicted according to the SPIE location-risk score and the 12-Gy-Volume.

Publication types

  • Multicenter Study

MeSH terms

  • Case-Control Studies
  • Follow-Up Studies
  • Forecasting
  • Humans
  • Injury Severity Score*
  • Intracranial Arteriovenous Malformations / pathology
  • Intracranial Arteriovenous Malformations / surgery*
  • Logistic Models
  • Models, Biological*
  • Multivariate Analysis
  • Radiosurgery / adverse effects*
  • Radiotherapy Dosage
  • Risk Assessment
  • Risk Factors