Recent Advances in Radiosurgery for Cerebral Arteriovenous Malformations: The University of Tokyo Experience

Abstract

Cerebral arteriovenous malformations (AVMs) frequently arise in the younger population and can cause severe disabilities or death [1, 2, 3]. Intracranial hemorrhage is the most common clinical presentation, and annual hemorrhage rate is reported to be 2 to 4% during the natural course of the disease [3, 4, 5, 6, 7, 8, 9]. Various treatments have been developed in an attempt to reduce the risk of hemorrhage. Stereotactic radiosurgery, in particular, has been widely used as one of the minimally invasive therapies during the past two decades [1, 2, 3,10, 11, 12, 13]. It provides an angiographic cure in 80 to 95 percent of patients with a latency period of 3 to 5 years [1,14, 15, 16, 17]. A lot of relevant studies have been reported to date all over the world. Recently, however, a lot of new facts were clarified by our up-to-date long-term follow-up study after stereotactic radiosurgery using a gamma knife (Elekta instruments, Norcross, GA, U.S.A.) during the past 15 years. Hereby we introduce several recent advances in both knowledge and technique.