title: Stereotactic radiosurgery for arteriovenous malformations of the cerebellum.
abstract: OBJECTIVE
  Arteriovenous malformations (AVMs) of the posterior fossa have an aggressive natural history and propensity for hemorrhage. Although the cerebellum accounts for the majority of the posterior fossa volume, there is a paucity of stereotactic radiosurgery (SRS) outcome data for AVMs of this region. The authors sought to evaluate the long-term outcomes and risks of cerebellar AVM radiosurgery.
  
  
  METHODS
  This single-institution retrospective analysis reviewed the authors' experience with Gamma Knife surgery during the period 1987-2007. During this time 64 patients (median age 47 years, range 8-75 years) underwent SRS for a cerebellar AVM. Forty-seven patients (73%) presented with an intracranial hemorrhage. The median target volume was 3.85 cm(3) (range 0.2-12.5 cm(3)), and the median marginal dose was 21 Gy (range 15-25 Gy).
  
  
  RESULTS
  Arteriovenous malformation obliteration was confirmed by MRI or angiography in 40 patients at a median follow-up of 73 months (range 4-255 months). The actuarial rates of total obliteration were 53% at 3 years, 69% at 4 years, and 76% at 5 and 10 years. Elevated obliteration rates were statistically higher in patients who underwent AVM SRS without prior embolization (p = 0.005). A smaller AVM volume was also associated with a higher rate of obliteration (p = 0.03). Four patients (6%) sustained a hemorrhage during the latency period and 3 died. The cumulative rates of AVM hemorrhage after SRS were 6% at 1, 5, and 10 years. This correlated with an overall annual hemorrhage rate of 2.0% during the latency interval. One patient experienced a hemorrhage 9 years after confirmed MRI and angiographic obliteration. A permanent neurological deficit due to adverse radiation effects developed in 1 patient (1.6%) and temporary complications were seen in 2 additional patients (3.1%).
  
  
  CONCLUSIONS
  Stereotactic radiosurgery proved to be most effective for patients with smaller and previously nonembolized cerebellar malformations. Hemorrhage during the latency period occurred at a rate of 2.0% per year until obliteration occurred.
authors.affiliation: Departments of Neurological Surgery and.
authors.forename: Greg
authors.initials: G
authors.lastname: Bowden
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kano
authors.forename: Daniel
authors.initials: D
authors.lastname: Tonetti
authors.forename: Ajay
authors.initials: A
authors.lastname: Niranjan
authors.forename: John
authors.initials: J
authors.lastname: Flickinger
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002531:Cerebellum / Q000098:blood supply / Q000601:surgery*; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult