Risk for hemorrhage during the 2-year latency period following gamma knife radiosurgery for arteriovenous malformations

Abstract

Purpose: Radiosurgery does not immediately obliterate an arteriovenous malformation (AVM), and the risk for hemorrhage still persists until the AVM is occluded. There is controversy about whether this risk is altered after as compared to before radiosurgery. The aim of this paper is to study this topic further and to suggest a model to predict the risk for posttreatment hemorrhage. Methods and Materials: The incidence of hemorrhages within the first 24 months following Gamma Knife radiosurgery was studied retrospectively among 1593 AVM patients, and was related to patient, AVM, and treatment parameters. Results: Fifty-six patients experienced a hemorrhage in the latency period, representing an average annual incidence of 1.8%. The incidence of posttreatment hemorrhage was related to the patient’s age, AVM volume, minimum dose, and average dose delivered to the AVM nidus. Based on these observations, an equation was defined that could quantify the probability for a posttreatment hemorrhage to occur. Conclusion: A model that can predict the probability for a hemorrhage within the first 24 months after radiosurgery is presented. The risk is higher for larger AVMs and for older patients, and it is lower when higher doses of radiation are used.