Arteriovenous Malformation

  • Katelyn M. Atkins
  • Marc Bussière
  • Helen A. ShihEmail author


Stereotactic radiosurgery was used for many years for the treatment of arteriovenous malformation. The principles of SRS have been applied to fractionated stereotactic radiotherapy techniques for treatment of a variety of commonly treated benign tumors and functional disorders of the CNS. This chapter summarizes hypofractionated radiotherapy techniques, including SRS and FSRT, for arteriovenous malformation.


Arteriovenous malformation Stereotactic radiosurgery SRS FSRT Benign CNS 


  1. 1.
    Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand. 1951;102(4):316–9.PubMedGoogle Scholar
  2. 2.
    Leksell L. Trigeminal neuralgia. Some neurophysiologic aspects and a new method of therapy. Lakartidningen. 1971;68(45):5145–8.PubMedGoogle Scholar
  3. 3.
    Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65(4):476–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Hamilton MG, Spetzler RF. The prospective application of a grading system for arteriovenous malformations. Neurosurgery. 1994;34(1):2–6; discussion-7PubMedGoogle Scholar
  5. 5.
    Pollock BE, Flickinger JC. Modification of the radiosurgery-based arteriovenous malformation grading system. Neurosurgery. 2008;63(2):239–43; discussion 43CrossRefPubMedGoogle Scholar
  6. 6.
    Blamek S, Larysz D, Miszczyk L, Idasiak A, Rudnik A, Tarnawski R. Hypofractionated stereotactic radiotherapy for large or involving critical organs cerebral arteriovenous malformations. Radiol Oncol. 2013;47(1):50–6.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kano H, Kondziolka D, Flickinger JC, Park KJ, Parry PV, Yang HC, et al. Stereotactic radiosurgery for arteriovenous malformations, part 6: multistaged volumetric management of large arteriovenous malformations. J Neurosurg. 2012;116(1):54–65.CrossRefPubMedGoogle Scholar
  8. 8.
    Seymour ZA, Sneed PK, Gupta N, Lawton MT, Molinaro AM, Young W, et al. Volume-staged radiosurgery for large arteriovenous malformations: an evolving paradigm. J Neurosurg. 2016;124(1):163–74.CrossRefPubMedGoogle Scholar
  9. 9.
    Balagamwala EH, Suh JH, Barnett GH, Khan MK, Neyman G, Cai RS, et al. The importance of the conformality, heterogeneity, and gradient indices in evaluating Gamma Knife radiosurgery treatment plans for intracranial meningiomas. Int J Radiat Oncol Biol Phys. 2012;83(5):1406–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Ding D, Yen CP, Xu Z, Starke RM, Sheehan JP. Radiosurgery for low-grade intracranial arteriovenous malformations. J Neurosurg. 2014;121(2):457–67.CrossRefPubMedGoogle Scholar
  11. 11.
    Hattangadi-Gluth JA, Chapman PH, Kim D, Niemierko A, Bussiere MR, Stringham A, et al. Single-fraction proton beam stereotactic radiosurgery for cerebral arteriovenous malformations. Int J Radiat Oncol Biol Phys. 2014;89(2):338–46.CrossRefPubMedGoogle Scholar
  12. 12.
    Hattangadi JA, Chapman PH, Bussiere MR, Niemierko A, Ogilvy CS, Rowell A, et al. Planned two-fraction proton beam stereotactic radiosurgery for high-risk inoperable cerebral arteriovenous malformations. Int J Radiat Oncol Biol Phys. 2012;83(2):533–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Mayo C, Martel MK, Marks LB, Flickinger J, Nam J, Kirkpatrick J. Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S28–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys. 1993;27(2):215–21.CrossRefPubMedGoogle Scholar
  15. 15.
    Kano H, Kondziolka D, Khan A, Flickinger JC, Lunsford LD. Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg. 2009;111(4):863–73.CrossRefPubMedGoogle Scholar
  16. 16.
    Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, et al. Stereotactic body radiation therapy: the report of AAPM task group 101. Med Phys. 2010;37(8):4078–101.CrossRefPubMedGoogle Scholar
  17. 17.
    Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S10–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kano H, Lunsford LD, Flickinger JC, Yang HC, Flannery TJ, Awan NR, et al. Stereotactic radiosurgery for arteriovenous malformations, Part 1: management of Spetzler-Martin Grade I and II arteriovenous malformations. J Neurosurg. 2012;116(1):11–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Silander H, Pellettieri L, Enblad P, Montelius A, Grusell E, Vallhagen-Dahlgren C, et al. Fractionated, stereotactic proton beam treatment of cerebral arteriovenous malformations. Acta Neurol Scand. 2004;109(2):85–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Moosa S, Chen CJ, Ding D, Lee CC, Chivukula S, Starke RM, et al. Volume-staged versus dose-staged radiosurgery outcomes for large intracranial arteriovenous malformations. Neurosurg Focus. 2014;37(3):E18.CrossRefPubMedGoogle Scholar
  21. 21.
    Pollock BE, Kline RW, Stafford SL, Foote RL, Schomberg PJ. The rationale and technique of staged-volume arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys. 2000;48(3):817–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Pan DH, Guo WY, Chung WY, Shiau CY, Chang YC, Wang LW. Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations. J Neurosurg. 2000;93(Suppl 3):113–9.PubMedGoogle Scholar
  23. 23.
    Flores GL, Sallabanda K, dos Santos MA, Gutiérrez J, Salcedo JCBP, Beltrán C, et al. Linac stereotactic radiosurgery for the treatment of small arteriovenous malformations: lower doses can be equally effective. Stereotact Funct Neurosurg. 2011;89(6):338–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Starke RM, Yen CP, Ding D, Sheehan JP. A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients. J Neurosurg. 2013;119(4):981–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Vernimmen FJ, Slabbert JP, Wilson JA, Fredericks S, Melvill R. Stereotactic proton beam therapy for intracranial arteriovenous malformations. Int J Radiat Oncol Biol Phys. 2005;62(1):44–52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Katelyn M. Atkins
    • 1
  • Marc Bussière
    • 2
  • Helen A. Shih
    • 2
    Email author
  1. 1.Department of Radiation OncologyMassachusetts General HospitalBostonUSA
  2. 2.Department of Radiation OncologyMassachusetts General Hospital, Francis H. Burr Proton Therapy CenterBostonUSA

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