Dose-staged stereotactic radiosurgery outcomes for large arteriovenous malformations

Objective: Describe our experience to treat large arteriovenous malformations (AVMs) with dose-staged (DS) stereotactic radiosurgery (SRS).

Methods: Since September of 2008, until January of 2014, the minimum follow up of three years, median of 61 months, we have treated 28 patients with large AVMs, mean age were 26 years. There was no deference in gender, 14 each. Seven were classified with Spetzler-Martin grade V, 13 with Spetzler-Martin grade IV and 7 with Spetzler-Martin modified by Oliveira as grade 3A. All patients were treated from Monday through Friday, 5 patients received a dose of 650 cGy a day, 16 received 600 cGy a day and 5 patients received a dose of 550 cGy a day and 2 patients received a dose of 500 cGy a day.

Results: The mean obliteration rates for DS-SRS were 21,43%. One patient had a post-SRS hemorrhage and died. In three patients there were any results at all. We start to treat with five times 650 cGy, but we had some stable motor complications and we decreased the dose to five times 600, with this, we have image complications, hyper signal in T2 and some motor deficits but all patients recovered.

Conclusions: Even we know that large brain AVMs need a long follow up, DS-SRS may be reasonable treatment approach for large AVMs.