title: Seizure outcomes following radiosurgery for cerebral arteriovenous malformations.
abstract: OBJECTIVE
  Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs.
  
  
  METHODS
  A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome.
  
  
  RESULTS
  Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16-17.44; p = 0.0007).
  
  
  CONCLUSIONS
  Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.
authors.affiliation: Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Srinivas
authors.initials: S
authors.lastname: Chivukula
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D039781:PubMed / Q000706:statistics & numerical data; D016634:Radiosurgery / Q000009:adverse effects*; D012640:Seizures / Q000209:etiology*
keywords: AED = antiepileptic drug; AVM = arteriovenous malformation; GKRS = Gamma Knife radiosurgery; PBT = proton-beam therapy; SRS = stereotactic radiosurgery; arteriovenous malformation; epilepsy; review; seizure; stereotactic radiosurgery