Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Radiosurgery Society Case-Based Guide

Rojine T Ariani; Eulanca Y Liu; Victor Goulenko; Patrick Travis Courtney; Felix Ehret; Karin A Skalina; Fatemeh Fekrmandi; Tania Kaprealian; Stephen Tenn; Ricky R Savjani; Dheerendra Prasad; Michael Schulder

doi:10.1016/j.prro.2026.04.001

Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Radiosurgery Society Case-Based Guide

Pract Radiat Oncol. 2026 Apr 21:S1879-8500(26)00111-6. doi: 10.1016/j.prro.2026.04.001. Online ahead of print.

Affiliations

¹ Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California. Electronic address: rariani@mednet.ucla.edu.
² Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California.
³ Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
⁴ Charité - Universitätsmedizin Berlin, Department of Radiation Oncology, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité - Universitätsmedizin Berlin, Berlin, Germany; European Radiosurgery Center Munich, Munich, Germany.
⁵ Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, New York.
⁶ Department of Radiation Oncology, Ohio State University, Columbus, Ohio.
⁷ Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York; Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
⁸ Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.

PMID: 42026001
DOI: 10.1016/j.prro.2026.04.001

Abstract

Purpose: Brain arteriovenous malformations (AVMs) are high-risk vascular anomalies associated with hemorrhage, neurological morbidity, and mortality. Stereotactic radiosurgery (SRS) is a well-established, noninvasive treatment that achieves durable obliteration while preserving neurological function. This case-based guideline summarizes contemporary SRS-based AVM management and outcomes.

Methods and materials: Three illustrative cases were selected: a small, unruptured Spetzler-Martin grade (SMG) I AVM treated with single-fraction SRS, a large SMG V AVM managed with volume-staged SRS, and a ruptured SMG II AVM treated with embolization followed by definitive SRS.

Results: Single-fraction SRS achieves durable obliteration for small AVMs, whereas staged approaches allow safe treatment of large or complex lesions and complement microsurgery and embolization. Treatment planning emphasizes integration of advanced imaging, precise nidus delineation, and dose-volume optimization. Long-term surveillance remains essential to confirm obliteration and detect delayed complications.

Conclusions: This case-based guideline highlights practical principles of SRS for brain AVM management, emphasizing individualized selection, multidisciplinary collaboration, and meticulous planning to optimize safety and efficacy.