Dose Hypofractionated Stereotactic Radiotherapy for Intracranial Arteriovenous Malformations: A Case Series and Review of the Literature

Hiro Sparks, Arev Hovsepian, Bayard Wilson, Antonio De Salles, Michael Selch, Tania Kaprealian, Nader Pouratian

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Brain arteriovenous malformations (AVMs) are pathologic tangles of intracerebral vessels. The treatment of AVMs aims to reduce the risk of devastating intracranial hemorrhage (ICH). Hypofractionated stereotactic radiotherapy (HSRT) can be used to treat large lesions and reduce the risk of radiation toxicity to the surrounding structures. We analyzed the data from our institutional experience of the past 15 years in treating large AVMs with both 5- and 6-fraction HSRT and evaluated the pretreatment characteristics that are most predictive of the radiographic response. Methods: We included 37 patients and 42 treatments of intracranial AVMs measuring >3 cm in their largest dimension. Data were collected retrospectively by reviewing the electronic health records. The AVM volume was measured before HSRT and at the most recent follow-up appointment. Symptomatic outcomes, including treatment-related inflammation, were measured and defined categorically. Results: Complete obliteration was achieved in 11.9% of the patients. The mean AVM volume had decreased significantly after HSRT (P = 8.7e-8). The percentage of volume reduction differed significantly between patients receiving 30-Gy fractions, (∂V = −48.7%) and those receiving 25-Gy fractions (∂V = −29.1%; P = 0.035). Patients with partial or complete obliteration were more likely to have received a total dose of 30 Gy rather than 25 Gy (P = 0.056) and showed a trend toward being treatment naive (P = 0.053). Conclusion: HSRT can be used as a method to manage large AVMs, with obliteration in some cases and sufficient volume reduction in most others for adjuvant treatment with other modalities. The 30-Gy total dose was generally superior to 25 Gy in achieving obliteration or volume reduction. Further studies focused on longer follow-up periods are warranted.

Original languageEnglish (US)
Pages (from-to)e1456-e1467
JournalWorld neurosurgery
StatePublished - Jun 2019
Externally publishedYes


  • Dose fractionation
  • Intracranial arteriovenous malformations
  • Radiosurgery
  • Radiotherapy dosage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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