title: Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway.
abstract: OBJECTIVE
  A visual field deficit resulting from the management of an arteriovenous malformation (AVM) significantly impacts a patient's quality of life. The present study was designed to investigate the clinical and radiological outcomes of stereotactic radiosurgery (SRS) performed for AVMs involving the postgeniculate visual pathway.
  
  
  METHODS
  In this retrospective single-institution analysis, the authors reviewed their experience with Gamma Knife surgery for postgeniculate visual pathway AVMs performed during the period between 1987 and 2009.
  
  
  RESULTS
  During the study interval, 171 patients underwent SRS for AVMs in this region. Forty-one patients (24%) had a visual deficit prior to SRS. The median target volume was 6.0 cm3 (range 0.4-22 cm3), and 19 Gy (range 14-25 Gy) was the median margin dose. Obliteration of the AVM was confirmed in 80 patients after a single SRS procedure at a median follow-up of 74 months (range 5-297 months). The actuarial rate of total obliteration was 67% at 4 years. Arteriovenous malformations with a volume<5 cm3 had obliteration rates of 60% at 3 years and 79% at 4 years. The delivered margin dose proved significant given that 82% of patients receiving ≥22 Gy had complete obliteration. The AVM was completely obliterated in an additional 18 patients after they underwent repeat SRS. At a median of 25 months (range 11-107 months) after SRS, 9 patients developed new or worsened visual field deficits. One patient developed a complete homonymous hemianopia, and 8 patients developed quadrantanopias. The actuarial risk of sustaining a new visual deficit was 3% at 3 years, 5% at 5 years, and 8% at 10 years. Fifteen patients had hemorrhage during the latency period, resulting in death in 9 of the patients. The annual hemorrhage rate during the latency interval was 2%, and no hemorrhages occurred after confirmed obliteration.
  
  
  CONCLUSIONS
  Despite an overall treatment mortality of 5%, related to latency interval hemorrhage, SRS was associated with only a 5.6% risk of new visual deficit and a final obliteration rate close to 80% in patients with AVMs of the postgeniculate visual pathway.
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Greg
authors.initials: G
authors.lastname: Bowden
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kano
authors.forename: Ellen
authors.initials: E
authors.lastname: Caparosa
authors.forename: Daniel
authors.initials: D
authors.lastname: Tonetti
authors.forename: Ajay
authors.initials: A
authors.lastname: Niranjan
authors.forename: Edward A
authors.initials: EA
authors.lastname: Monaco
authors.forename: John
authors.initials: J
authors.lastname: Flickinger
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Arai
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005829:Geniculate Bodies / Q000528:radiation effects*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology* / Q000503:physiopathology; D014794:Visual Fields / Q000502:physiology / Q000528:radiation effects; D014795:Visual Pathways / Q000503:physiopathology / Q000528:radiation effects*; D055815:Young Adult
keywords: ARE = adverse radiation effect; AVM; AVM = arteriovenous malformation; Gamma Knife; SRS = stereotactic radiosurgery; arteriovenous malformation; optic radiation; stereotactic radiosurgery; vascular disorders; vision