Risks and Benefits of Arteriovenous Malformation Radiosurgery

摘要

Stereotactic radiosurgery is a highly effective and relatively noninvasive treatment of arteriovenous malformations (AVMs). The expected risks and benefits of radiosurgery vary for individual patients and need to be evaluated in deciding upon a management strategy. The lifetime hemorrhage risk of untreated AVM patients depends mainly on their expected life span. Radiosurgery can eliminate this risk of hemorrhage in approximately 75% of all AVM patients within 3 years of the procedure and can be repeated after 3 years. Individual obliteration rates vary from 50 to 88% depending upon marginal dose. Although AVM obliteration rates appear to be optimum with marginal doses of approximately 23 Gy, lower doses are selected for most patients to minimize complications. Complication risk prediction models take into account marginal dose, AVM volume, and location. There is also a risk of hemorrhage while waiting for complete obliteration. All these risks and benefits of radiosurgery need to be considered together to optimize management of individual AVM patients.