Stereotactic Radiosurgery for Arteriovenous Malformations of the Cerebellum

J Neurosurg. 2014 Mar;120(3):583-90. doi: 10.3171/2013.9.JNS131022. Epub 2013 Oct 25.

Abstract

Object: Arteriovenous malformations (AVMs) of the posterior fossa have an aggressive natural history and propensity for hemorrhage. Although the cerebellum accounts for the majority of the posterior fossa volume, there is a paucity of stereotactic radiosurgery (SRS) outcome data for AVMs of this region. The authors sought to evaluate the long-term outcomes and risks of cerebellar AVM radiosurgery.

Methods: This single-institution retrospective analysis reviewed the authors' experience with Gamma Knife surgery during the period 1987-2007. During this time 64 patients (median age 47 years, range 8-75 years) underwent SRS for a cerebellar AVM. Forty-seven patients (73%) presented with an intracranial hemorrhage. The median target volume was 3.85 cm(3) (range 0.2-12.5 cm(3)), and the median marginal dose was 21 Gy (range 15-25 Gy).

Results: Arteriovenous malformation obliteration was confirmed by MRI or angiography in 40 patients at a median follow-up of 73 months (range 4-255 months). The actuarial rates of total obliteration were 53% at 3 years, 69% at 4 years, and 76% at 5 and 10 years. Elevated obliteration rates were statistically higher in patients who underwent AVM SRS without prior embolization (p = 0.005). A smaller AVM volume was also associated with a higher rate of obliteration (p = 0.03). Four patients (6%) sustained a hemorrhage during the latency period and 3 died. The cumulative rates of AVM hemorrhage after SRS were 6% at 1, 5, and 10 years. This correlated with an overall annual hemorrhage rate of 2.0% during the latency interval. One patient experienced a hemorrhage 9 years after confirmed MRI and angiographic obliteration. A permanent neurological deficit due to adverse radiation effects developed in 1 patient (1.6%) and temporary complications were seen in 2 additional patients (3.1%).

Conclusions: Stereotactic radiosurgery proved to be most effective for patients with smaller and previously nonembolized cerebellar malformations. Hemorrhage during the latency period occurred at a rate of 2.0% per year until obliteration occurred.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cerebellum / blood supply
  • Cerebellum / surgery*
  • Child
  • Embolization, Therapeutic
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Arteriovenous Malformations / complications*
  • Intracranial Arteriovenous Malformations / mortality
  • Intracranial Arteriovenous Malformations / surgery*
  • Intracranial Hemorrhages / etiology*
  • Intracranial Hemorrhages / mortality
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Radiosurgery / adverse effects*
  • Radiosurgery / methods*
  • Retrospective Studies
  • Risk Factors
  • Young Adult