title: Staged-volume radiosurgery for large arteriovenous malformations: a review.
abstract: Stereotactic radiosurgery is an effective management strategy for properly selected patients with arteriovenous malformations (AVMs). However, the risk of postradiosurgical radiation-related injury is higher in patients with large AVMs. Multistaged volumetric management of large AVMs was undertaken to limit the radiation exposure to the surrounding normal brain. This strategy offers a promising method for obtaining high AVM obliteration rates with minimal normal tissue damage. The use of embolization as an adjunctive method in the treatment of large AVMs remains controversial. Unfortunately, staged-volume radiosurgery (SVR) has a number of potential pitfalls that affect the outcome. The aim of this article is to highlight the role of SVR in the treatment of large AVMs, to discuss the outcome comparing it to other treatment modalities, and to discuss the potential improvement that could be introduced to this method of treatment.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: Kenan
authors.initials: K
authors.lastname: AlKhalili
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D001165:Arteriovenous Malformations / Q000601:surgery*; D006801:Humans; D016634:Radiosurgery; D016896:Treatment Outcome
keywords: AVM = arteriovenous malformation; GKS = Gamma Knife surgery; LINAC = linear accelerator; SRS = stereotactic radiosurgery; SVR = staged-volume radiosurgery; Spetzler-Martin Grade; arteriovenous malformation; embolization; staged volume; stereotactic radiosurgery