Long-Term Outcomes of Single-Session Stereotactic Radiosurgery for Cerebellar Arteriovenous Malformation, with a Median Follow-Up of 10 Years

Abstract

Cerebellar arteriovenous malformation (C-AVM) is poorly tolerated because of its aggressive natural history. The aim of this study was to delineate long-term outcomes of Gamma Knife stereotactic radiosurgery (GKRS) for C-AVM. The outcomes of 45 patients who underwent GKRS for C-AVMs at our institution were retrospectively analyzed. Event-free survival was defined as free from any neurologic deficits caused by AVMs or adverse phenomena from the treatment. The median age and follow-up were 41 years (range, 6-77 years) and 120 months (range, 5-291 months), respectively. The median volume and Pollock-Flickinger radiosurgical AVM score were 1.3 cm3 (range, 0.1-8.3 cm3) and 1.26 (range, 0.5-2.06), respectively. Actuarial obliteration rates were 46%, 75%, and 90% at 3, 5, and 6 years, respectively. Multivariate analysis showed that the maximal diameter ≤15 mm (P= 0.021) and margin dose >20 Gy (P= 0.0008) were significantly associated with better obliteration. Four patients experienced posttreatment hemorrhages, and annual hemorrhage rates were 1.9% and 0.30% before and after obliteration, respectively. One patient died because of hemorrhage, whereas the other 3 patients spontaneously recovered. Perifocal edema was confirmed in 8 (16%); however, no symptomatic edema was observed. Overall, neurologic deteriorations were noted in 4 patients; 3 were because of posttreatment hemorrhage, and 1 was because of pretreatment angiography. The event-free survival rates were 96%, 93%, and 93% at 4, 10, and 15 years, respectively. GKRS is a reasonable intervention for C-AVMs. Symptomatic complications are rare, and the long-term outcomes are favorable.