Management Of Arteriovenous Malformations Research Articles

Retraction Note: Artificial intelligence in the surgical management of arteriovenous malformations.

Retraction Note: Artificial intelligence in the surgical management of arteriovenous malformations.

Thalamic Arteriovenous Malformations: A Systematic Review of Presentation, Diagnostic Modalities, and Treatment Approaches.

Thalamic arteriovenous malformations (AVMs) are rare, deep-seated vascular lesions associated with a high risk of hemorrhage and significant neurological deficits. Due to their complex anatomy, these lesions present unique challenges in management. Various therapeutic approaches, including microsurgical resection, stereotactic radiosurgery, and embolization, have been employed to address these challenges. This systematic review examines the clinical presentation, diagnostic modalities, treatment outcomes, and complications associated with thalamic AVMs. A comprehensive literature search was conducted in PubMed, Scopus, and Rayyan databases, focusing on studies reporting clinical outcomes of patients with thalamic AVMs. Eligible studies included those assessing treatment outcomes for surgical resection, stereotactic radiosurgery (SRS), and embolization. Data extraction and risk of bias assessments were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nineteen studies, comprising a total of 97 patients, were included. Radiosurgery was the most frequently employed treatment, with obliteration rates ranging from 66.7% to 82%, though it carried a risk of post-treatment complications such as rebleeding (5.9%) and neurological deficits (17%). Microsurgery achieved obliteration rates of up to 71%, but this was associated with significant perioperative risks. In comparison, radiosurgery demonstrated obliteration rates ranging from 66.7% to 82%, offering a balance between safety and efficacy for most patients. Embolization, though less commonly used, showed promise in select cases, while conservative management was effective for patients in whom surgery posed an excessive risk. The management of thalamic AVMs is multidisciplinary, with treatment decisions tailored to individual AVM characteristics, patient status, and risk profiles over time. Microsurgical resection remains an option for cases requiring immediate intervention.

A rare case of uterine arteriovenous malformation masquerading as retained products of conceptus: a case report

An Arteriovenous malformation (AVM) is essentially an abnormal vascular structural anomalous connection between arteries and veins that bypass the capillaries.1 While they can be found anywhere in the body, uterine AVMs are relatively rare with only about 100 cases having been reported in literature to date. Herein, we describe an atypical presentation and subsequent management of a uterine AVM which initially appeared to resemble products of conceptus. It is important to differentiate between the two conditions since the management of the former differs widely from the latter and involves a specialized unit.

Advancements in radiosurgery for the treatment of arteriovenous malformations

Arteriovenous malformations (AVMs) are complex vascular anomalies with high risks of hemorrhage and neurological deficits. The evolution of stereotactic radiosurgery (SRS) represents a significant advancement in their management, offering a less invasive alternative to traditional surgical approaches. This study aims to evaluate recent developments in SRS techniques for treating AVMs by conducting an integrative literature review. Utilizing the PICO strategy, a systematic search was performed across databases like LILACS, MEDLINE, and SCIELO, focusing on clinical trials, observational studies, meta-analyses, and systematic reviews. The analysis revealed that while microsurgical excision remains a definitive approach, SRS—particularly with advanced systems like Gamma Knife, Linac, CyberKnife, and Zap-X—has shown promising results in reducing hemorrhage rates and lesion volumes with lower complications. The findings indicate that SRS, bolstered by improved imaging and radiation precision, provides a viable alternative to invasive methods, though its effectiveness varies among different systems. This review underscores the need for a multidisciplinary approach in AVM management, emphasizing tailored treatment strategies based on lesion characteristics and patient-specific factors.

Arteriovenous Malformations in Osler-Weber-Rendu Syndrome: Pathophysiology, Clinical Manifestations, and Advances in Management

Osler-Weber-Rendu Syndrome, or Hereditary Hemorrhagic Telangiectasia (HHT), is a rare genetic disorder marked by the development of arteriovenous malformations (AVMs) throughout the body. These abnormal vascular connections bypass the capillary network, leading to significant clinical challenges. This article reviews the pathophysiology, clinical manifestations, and advances in the management of AVMs in HHT. The genetic basis of HHT involves mutations in the ENG, ACVRL1, and SMAD4 genes, which play critical roles in the TGF-β signaling pathway. These mutations result in endothelial dysfunction, contributing to the formation of AVMs. The clinical impact of AVMs is significant, particularly when they occur in the brain, lungs, liver, or gastrointestinal tract, where they can lead to life-threatening complications. This review also explores current diagnostic and management strategies, emphasizing the importance of a multidisciplinary approach. Interventional techniques such as embolization, stereotactic radiosurgery, and microsurgical resection are discussed, alongside emerging therapies like anti-angiogenic drugs and gene therapy. These advancements have led to more personalized and effective treatment plans for patients. As a result, the management of AVMs in HHT has seen significant progress, with a growing emphasis on individualized care. Continued research and the development of specialized treatment centers are crucial for further improving patient outcomes in this complex condition.

Multidisciplinary approach to hand arteriovenous malformations: treatment strategies and clinical outcomes - insights from a 25-year experience at a single vascular anomalies center

ObjectiveHand arteriovenous malformations (AVMs) are extremely difficult to manage for their functional importance and cosmetic disfiguration. A single-center retrospective study was conducted to identify long-term outcomes of multidisciplinary team management of hand AVMs. MethodsInstitutional review board approved this retrospective study. Multidisciplinary vascular anomalies center data was reviewed from 1995 to 2023. Patient demographics, Schobinger’s AVM stage, sclerotherapy details, surgical history, and adverse events after sclerotherapy were reviewed. ResultsA total of 150 patients with hand AVMs visited our hospital from 1995 to 2023, with a mean age of 33 years (range, 1-75 years), and 91 were females. Forty-four patients were Schobinger stage II, and 106 were stage III. Sclerotherapy was performed on 101 patients (67%) with 320 sessions. Angiographic devascularization rates after sclerotherapy were: 16 with 100%, 30 with over 90%, 34 with 50% to 90%, 15 with 0% to 50%, and six showed aggravation. Sclerotherapy-related adverse events occurred in 123 of 320 sessions (39%), with 112 minor and 11 major events. Fifteen patients (15%) eventually underwent amputation surgery a mean of 1618 days after sclerotherapy for necrosis (n = 3) and delayed complications (n = 12). Thirteen patients (9%) underwent primary surgical amputation for ulcers or bleeding (all Schobinger stage III). Thirty-six patients (24%) were followed without any procedure. ConclusionsMultidisciplinary management of hand AVMs shows varied long-term outcomes. Although sclerotherapy is effective for many patients, it carries a significant risk of adverse events. The necessity for amputation in some cases highlights the severity of advanced AVMs and the need for individualized treatment approaches.

Intraventricular hemorrhage secondary to ruptured arteriovenous malformation: A case report

Introduction: An arteriovenous malformation (AVM) is a lesion in which the feeding artery and the draining vein are connected by a coiled, tortuous vascular link. This nidus is where arteriovenous shunting occurs. While pediatric AVM is uncommon, there has been evidence of possible impairments and an increased risk of hemorrhage. This study aimed to elaborate on a rare case of pediatric arteriovenous malformation with intraventricular hemorrhage. Case report: A male patient, fifteen years of age, was referred from P hospital due to a severe headache that was accompanied by nausea and vomiting two days prior to hospital admission. Chief Computed Tomography Digitizing and Angiographic Images In the left lateral ventricle, the posterior horn of the right lateral ventricle, the third ventricle, and the left pericallosal area AVM (Spletzer Martin grading: 2), intraventricular hemorrhage (IVH), and moderate cerebral edema were all seen during an angiography. AVM was managed conservatively with head positioning 30o, analgesics, and ranitidine. Phenytoin was given as a precaution for seizure in intracerebral hemorrhage. The headache improved gradually during the hospital stay. Upon follow-up at the outpatient clinic, headache and other neurological symptoms were absent, and the patient had typical vital signs. Conclusion: AVM rupture can cause IVH that occurs more often in young patients. Management of pediatric AVM requires discussion among pediatric neurologists, neurosurgeons, and interventional radiologists to decide the best care for the patient. AVM patients who received conservative treatment had a higher risk of bleeding and, therefore, required routine monitoring.

Recent Advances in Understanding and Management of Arteriovenous Malformations of the Temporal Skin Area

Context: Arteriovenous malformations (AVMs) of the temporal skin area, though less common than cerebral AVMs, pose significant challenges in terms of cosmetic and functional outcomes. Over the past decade, substantial advancements have been made in the understanding and management of these lesions. This paper aims to review the latest developments in the pathophysiology, diagnosis, and treatment of temporal skin AVMs, and to explore ongoing challenges and emerging research directions. Evidence Acquisition: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. The focus was on research published in the past ten years related to temporal skin AVMs, including reviews, clinical studies, and advancements in treatment techniques. Results: The review discusses the evolution in understanding the pathophysiology of temporal skin AVMs, improvements in diagnostic imaging techniques, and the refinement of surgical and non-surgical treatment approaches. The outcomes, including cosmetic and functional results, and complications associated with various treatments, are also presented. Conclusions: The management of temporal skin AVMs has benefited from multidisciplinary approaches, combining surgery, interventional radiology, and dermatology. However, challenges remain in achieving optimal cosmetic and functional outcomes, necessitating ongoing research and innovation.

MICROSURGERY AND STEREOTACTIC RADIOSURGERY FOR TREATMENT OF PATIENTS WITH BRAIN ARTERIOVENOUS MALFORMATION

Cerebral arteriovenous malformations (AVMs) pose a significant challenge in clinical management due to their complex nature and potential for severe complications. This review provides a comprehensive analysis of therapeutic options for AVMs, including microsurgery, stereotactic radiosurgery (SRS), and embolization, based on a thorough examination of existing literature. Eight studies involving 817 patients underscored microsurgery’s superiority in achieving complete obliteration of AVMs and reducing the risk of bleeding during follow-up, despite a higher incidence of post-operative neurological deficits. Notably, the success of microsurgery correlated with the severity of AVMs, with higher grades exhibiting lower success rates. Meanwhile, SRS offers a less invasive alternative but presents challenges such as a latency period until complete obliteration and risks associated with radiation. Embolization serves as a valuable adjunctive therapy, often utilized preoperatively to reduce bleeding risk. Combined approaches, such as embolization followed by radiosurgery, show promise in certain cases. However, treatment selection necessitates a personalized, multidisciplinary approach, considering AVM severity, location, and patient-specific factors. Post-operative care plays a crucial role in patient recovery and favorable outcomes, emphasizing the importance of monitoring and intervention to prevent complications. Despite advancements, further research is warranted to fully assess therapeutic options and ensure patient safety and efficacy. Collaboration among specialists is essential to optimize treatment strategies and enhance patient outcomes in AVM management.

Defining the Role of Oral Pathway Inhibitors as Targeted Therapeutics in Arteriovenous Malformation Care.

Arteriovenous malformations (AVMs) are vascular malformations that are prone to rupturing and can cause significant morbidity and mortality in relatively young patients. Conventional treatment options such as surgery and endovascular therapy often are insufficient for cure. There is a growing body of knowledge on the genetic and molecular underpinnings of AVM development and maintenance, making the future of precision medicine a real possibility for AVM management. Here, we review the pathophysiology of AVM development across various cell types, with a focus on current and potential druggable targets and their therapeutic potentials in both sporadic and familial AVM populations.

The current landscape of machine learning-based radiomics in arteriovenous malformations: a systematic review and radiomics quality score assessment.

Arteriovenous malformations (AVMs) are rare vascular anomalies involving a disorganization of arteries and veins with no intervening capillaries. In the past 10 years, radiomics and machine learning (ML) models became increasingly popular for analyzing diagnostic medical images. The goal of this review was to provide a comprehensive summary of current radiomic models being employed for the diagnostic, therapeutic, prognostic, and predictive outcomes in AVM management. A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, in which the PubMed and Embase databases were searched using the following terms: (cerebral OR brain OR intracranial OR central nervous system OR spine OR spinal) AND (AVM OR arteriovenous malformation OR arteriovenous malformations) AND (radiomics OR radiogenomics OR machine learning OR artificial intelligence OR deep learning OR computer-aided detection OR computer-aided prediction OR computer-aided treatment decision). A radiomics quality score (RQS) was calculated for all included studies. Thirteen studies were included, which were all retrospective in nature. Three studies (23%) dealt with AVM diagnosis and grading, 1 study (8%) gauged treatment response, 8 (62%) predicted outcomes, and the last one (8%) addressed prognosis. No radiomics model had undergone external validation. The mean RQS was 15.92 (range: 10-18). We demonstrated that radiomics is currently being studied in different facets of AVM management. While not ready for clinical use, radiomics is a rapidly emerging field expected to play a significant future role in medical imaging. More prospective studies are warranted to determine the role of radiomics in the diagnosis, prediction of comorbidities, and treatment selection in AVM management.

Changes in inpatient brain arteriovenous malformation management in the United States following the ARUBA trial: analysis of an interrupted time series design

The November 2013 online publication of ARUBA, the first multi-institutional randomized controlled trial for unruptured brain arteriovenous malformations (AVMs), has sparked over 100 publications in protracted debates MethodsThis study sought to examine inpatient management patterns of brain AVMs from 2009 to 2016 and observe if changes in U.S. inpatient management were attributable to the ARUBA publication using interrupted time series of brain AVM studies from the National Inpatient Sample data 2009–2016. Outcomes of interest were use of embolization, surgery, combined embolization and microsurgery, radiotherapy, and observation during that admission. An interrupted time series design compared management trends before and after ARUBA. Segmented linear regression analysis tested for immediate and long-term impacts of ARUBA on management. ResultsElective and asymptomatic patient admissions declined 2009–2016. In keeping with the ARUBA findings, observation for unruptured brain AVMs increased and microsurgery decreased. However, embolization, radiosurgery, and combined embolization and microsurgery also increased. For ruptured brain AVMs, treatment modality trends remained positive with even greater rates of observation, embolization, and combined embolization and microsurgery occurring after ARUBA (data on radiosurgery were scarce). None of the estimates for the change in trends were statistically significant. ConclusionsThe publication of ARUBA was associated with a decrease in microsurgery and increase in observation for unruptured brain AVMs in the US. However, inpatient radiotherapy, embolization, and combined embolization and surgery also increased, suggesting trends moved counter to ARUBA’s conclusions. This analysis suggested that ARUBA had a small impact as clinicians rejected ARUBA’s findings in managing unruptured brain AVMs.

Evidence-based Decision-making on Management of Arteriovenous Malformation of Face

Abstract Arteriovenous malformations (AVMs) are uncommon inborn vascular anomaly, making for about 1.5% of all vascular aberrations. Remarkably, approximately half of AVM cases manifest in the mouth cavity and faciomaxillary region. A female patient, age 18 with an AVM on the right side of her face, is the subject of this case report. She had soft, compressible, nontender swelling on the right side of her face since birth; this swelling had gotten worse with age and she had surgery for it when she was 8 years old. The three-dimensional computed tomography scan of the face with angiography was done with findings of heterogeneous soft-tissue density lesion with increased volume, measuring 7.15 cm × 3.2 cm × 6.23 cm involving the right cheek. The surgery was planned through an intraoral approach over the right buccal mucosa with surgical excision and debulking with primary closure with the remaining buccal mucosa was done. Then, the patient kept on follow-up and the potential results were observed.

311 Rupture-Risk Stratifying Patients With Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements

INTRODUCTION: Up to 60% of cerebral arteriovenous malformations (AVMs) present with an intracranial hemorrhage, however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention. Although AVM rupture risk relies primarily on angioarchitectural features, measuring hemodynamic flow is gaining traction. An accurate understanding of AVM hemodynamic flow parameters will help stratify patients by rupture risk and select treatment plans. METHODS: The literature was reviewed for articles that quantified AVM flow. RESULTS: Quantitative digital subtraction angiography (QDSA), 4D spin-labeled magnetic resonance angiography (4D-SL-MRA), and 4D-Flow magnetic resonance imaging (4D-Flow-MRI) studies measure relative flow; 3D phase-contrast MRI (PC-MRI) studies measure relative and true flow; and quantitative MRA (QMRA) studies measure true flow. QDSA studies have correlated increased rupture risk with prolonged venous outflow, however there are mixed findings with respect to arterial inflow. Similarly, a higher AVM inflow-to-outflow ratio has been associated with greater rupture risk in studies using PC-MRI. 4D-SL-MRA studies, on the other hand, have demonstrated a lower time-to-peak draining-vein-to-feeder-artery ratio in patients with AVM rupture. Finally, 4D-Flow-MRI studies have shown inconsistent findings whereas QMRA studies have found no significant associations between AVM hemodynamic flow parameters and rupture risk. CONCLUSIONS: Quantitative hemodynamic studies on the relationship between AVM flow and rupture risk have not reached a clear consensus; however, the preponderance of data suggests that higher arterial inflow and lower venous outflow in the AVM nidus contribute to increased hemorrhagic risk. Future studies should consider using larger sample sizes and standardized definitions of hemodynamic parameters to reach a consensus. In the meantime, classic angioarchitectural features may be more strongly correlated with AVM rupture than the amount of blood flow.

Application of artificial intelligence in brain arteriovenous malformations: Angioarchitectures, clinical symptoms and prognosis prediction.

Artificial intelligence (AI) has rapidly advanced in the medical field, leveraging its intelligence and automation for the management of various diseases. Brain arteriovenous malformations (AVM) are particularly noteworthy, experiencing rapid development in recent years and yielding remarkable results. This paper aims to summarize the applications of AI in the management of AVMs management. Literatures published in PubMed during 1999-2022, discussing AI application in AVMs management were reviewed. AI algorithms have been applied in various aspects of AVM management, particularly in machine learning and deep learning models. Automatic lesion segmentation or delineation is a promising application that can be further developed and verified. Prognosis prediction using machine learning algorithms with radiomic-based analysis is another meaningful application. AI has been widely used in AVMs management. This article summarizes the current research progress, limitations and future research directions.

The role of GPRASP1 mutations in the pathogenesis of arteriovenous malformations

Arteriovenous Malformation (AVM) is a sporadic vascular disease caused by the aberrant direct connection between arterioles and veins, resulting in disorganized blood shunting and oxygen level disparities. Previous research has elucidated some of the genetic underpinnings of AVM and related vascular anomalies. Despite its significant prevalence, current therapeutic approaches remain largely conservative, underscoring the need for a deeper understanding of AVM pathogenesis. This study focuses on the GPRASP1 gene, which encodes the G-protein coupled receptor-associated sorting protein 1 (GASP-1), a molecule implicated in vascular development. Utilizing western blotting and cellular assays, we explored the role of GPRASP1 in angiogenesis, neoplastic formation, and other mechanical aspects of AVM. Our findings suggested that mutations in the GPRASP1 gene may contribute to elevated levels of angiogenic factors and altered cellular functions related to angiogenesis, such as enhanced proliferative and migratory capabilities. This research lays the groundwork for identifying novel therapeutic targets in the management of AVM and offers insights into precision medicine approaches.

Our Experience in the Surgical Management of Arterio-Venous Malformations of the head and neck

Vascular anomalies comprise a diverse group of abnormalities in blood vessel morphogenesis that usually occur prenatally. Arterio-venous malformations (AVMs) are rare congenital vascular lesions accounting for 1.5% of all vascular anomalies, with 50% of them occur in the oral and maxillo-facial regions. Treatment of large, complex vascular lesions is a serious challenge for patients and surgeons because it can cause disfigurement and massive haemorrhage, which may be spontaneous or the result of surgical intervention. Our study aimed to demonstrate surgical management of massive AVMs of the head and neck. This retrospective study shows the treatment outcomes of 28 patients with massive maxillo-facial vascular malformations, who presented to our department for treatment from 1 January 2015 to 31 July 2022. Twenty-eight patients with a mean age of 17.32 ± 12.21 years (women: 15, men: 13) were enrolled in the study. Diagnosis included extra cranial AVMs of the head and neck region. Treatment modalities, in isolation or combination, included angioembolisation procedure, sclerotherapy, and surgery. Management of AVMs is challenging owing to the replacement of normal tissue by the diseased ones and the high rate of recurrence. Hence, multi-modal approaches are needed for the effective restoration of tissues.

Functional Outcomes after Surgical Management of Peripheral AVM at a Tertiary Care Center

Abstract Introduction: Arteriovenous (AV) malformations (AVMs) are rare vascular developmental orders containing an arterial network draining directly into one or more veins without a capillary bed, accounting for 1.5% of total vascular anomalies. Clinical presentations include pulsating mass, pain, ulceration, bleeding, tissue necrosis, enlargement of draining vein, and venous hypertension and/or cardiac failure. Treatment modalities include surgical excision, coil embolization, and sclerotherapy. Surgical excision offers an opportunity for cure but is associated with a risk of injury to vital structures, causing permanent impairment. Due to the high-risk nature of the lesion, it is important to study the clinical presentation and management of peripheral AVM for better management of these patients. Objectives: The objective was to study the presentation, management, and postoperative outcomes in terms of recurrence and functional status of the limb after surgical management of AVMs. Patients and Methods: It was a retrospective study done for 5 years (2018–2023). Thirteen patients who underwent surgical excision of peripheral AVM were included. Recurrence and functional status were assessed by clinical evaluation during follow-up outpatient department visits. Conclusion: The mean age of presentation is 33 years, with male preponderance (70%). Seven patients had upper limb AVMs (four had forearm involvement, while the rest had elbow region involvement). Six patients had lower limb AVMs, out of which four patients had involvement of the thigh region, one had in the knee, and the other in the calf. All patients complained of difficulty in performing daily activities due to the lesion. Nine patients underwent direct surgical excision, and four patients underwent AVM embolization before surgery (three patients had coil embolization, and one had onyx embolization). The mean duration of stay in the hospital was 5 days. Three patients were advised body contour stockings at follow-up. Two patients had recurrence (one after 6 months of surgical excision and the other had prior coil embolization), and one patient (had preembolization) had continued difficulty in walking postprocedure. The rest of the patients did not develop recurrence/functional impairment. There was no postoperative mortality. Thus, surgical excision offers a chance at cure with durable, functional outcomes in patients with peripheral AVMs.

ПРАВОСТОРОННІЙ ГЕМОТОРАКС ЯК НАСЛІДОК АРТЕРІОВЕНОЗНОЇ МАЛЬФОРМАЦІЇ ЛЕГЕНЬ

Arteriovenous malformation of lung is a condition characterized by a direct connection of pulmonary artery system arteries with pulmonary veins and intrapulmonary right-to-left bypass formation. The prevalence of arteriovenous malformation is 1 per 50 000, observed more often in women. About 10 % of cases are diagnosed in childhood with the next rise of morbidity at the age of 50-60 years. Etiology is not studied yet. Clinical picture of arteriovenous malformation depends on a diameter of vessels, responsible for the bypass of blood. The most serious complication of arteriovenous malformation is a hemoptysis (pulmonary hemorrhage), hemothorax, abscess and brain infarction. Radiological methods, mainly spiral computed tomography of lung vessels, are the mainstay of diagnosis. Management of arteriovenous malformation is done using embolization of arterial vessels of affected area, resection of lung or combination of these methods. We present the clinical case of arteriovenous malformation, complicated by hemothorax. Key words: arteriovenous malformation, hemothorax, congenital hemorrhagic telangiectasia, video-assisted thoracoscopy, thoracic cavity computed tomography.

Predictors of radiation-induced changes in arteriovenous malformation patients undergoing radiosurgery: Insights from a Malaysian linear accelerator cohort.

Radiation-induced changes (RICs) post-stereotactic radiosurgery (SRS) critically influence outcomes in arteriovenous malformation (AVM) treatments. This study aimed to identify predictors of RICs, described the types and severity of RICs, and assessed their impact on patient's functional outcomes to enhance risk assessment and treatment planning for AVM patients. This retrospective study analyzed 87 AVM patients who underwent SRS at Hospital Kuala Lumpur between January 2015 and December 2020. RICs were identified through detailed magnetic resonance imaging evaluations, and predictive factors were determined using multiple logistic regression. Functional outcomes were assessed with the modified Rankin scale (mRS). Among the cohort, 40.2% developed RICs, with radiological RICs in 33.3%, symptomatic RICs in 5.7%, and permanent RICs in 1.1%. Severity categorization revealed 25.3% as Grade I, 13.8% as Grade II, and 1.1% as Grade III. Notably, higher Pollock-Flickinger scores and eloquence location were significant predictors of RIC occurrence. There was a significant improvement in functional outcomes post-SRS, with a marked decrease in non-favorable mRS scores from 8.0% pre-SRS to 1.1% post-SRS (P = 0.031). The study identified the eloquence location and Pollock-Flickinger scores as predictors of RICs post-SRS. The significant reduction in non-favorable mRS scores post-SRS underscores the efficacy of SRS in improving patient outcomes. Their results highlighted the importance of personalized treatment planning, focusing on precise strategies to optimize patient outcomes in AVM management, reducing adverse effects while improving functional outcomes.