title: Factors Determining the Clinical Complications of Radiosurgery for AVM.
abstract: OBJECTIVE
  To identify the predictors of symptomatic post-radiation T2 signal change in patients with arteriovenous malformations (AVM) treated with radiosurgery.
  
  
  METHODS
  The charts of 211 consecutive patients with arteriovenous malformations treated with either gamma knife radisurgery or linear accelerator radiosurgery between 2000-2009 were retrospectively reviewed. 168 patients had a minimum of 12 months of clinical and radiologic follow-up following the procedure and complete dosage data. Pretreatment characteristics and dosimetric variables were analyzed to identify predictors of adverse radiation effects.
  
  
  RESULTS
  141 patients had no clinical symptomatic complications. 21 patients had global or focal neurological deficits attributed to symptomatic edema. Variables associated with development of symptomatic edema included a non-hemorrhagic symptomatic presentation compared to presentation with hemorrhage, p=0.001; OR (95%CI) = 6.26 (1.99, 19.69); the presence of venous rerouting compared to the lack of venous rerouting, p=0.031; OR (95% CI) = 3.25 (1.20, 8.80); radiosurgery with GKS compared to linear accelerator radiosurgery p = 0.012; OR (95% CI) = 4.58 (1.28, 16.32); and the presence of more than one draining vein compared to a single draining vein p = 0.032; OR (95% CI) = 2.82 (1.06, 7.50).
  
  
  CONCLUSIONS
  We postulated that the higher maximal doses used with gamma knife radiosurgery may be responsible for the greater number of adverse radiation effects with this modality compared to linear accelerator radiosurgery. We found that AVMs with greater venous complexity and therefore instability resulted in more adverse treatment outcomes, suggesting that AVM angioarchitecture should be considered when making treatment decisions.
  
  
  
  Facteurs en cause dans les complications cliniques de la radiochirurgie pour une malformation artérioveineuse.
authors.forename: Matylda
authors.initials: M
authors.lastname: Machnowska
authors.forename: Patamintita
authors.initials: P
authors.lastname: Taeshineetanakul
authors.forename: Sasikhan
authors.initials: S
authors.lastname: Geibprasert
authors.forename: Ravi
authors.initials: R
authors.lastname: Menezes
authors.forename: Ronit
authors.initials: R
authors.lastname: Agid
authors.forename: Karel G
authors.initials: KG
authors.lastname: Terbrugge
authors.forename: Yuri
authors.initials: Y
authors.lastname: Andrade-Souza
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schwartz
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
mesh_terms: D006801:Humans; D002538:Intracranial Arteriovenous Malformations; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome