2. Consultant Radiation Oncologist, King Fahad Medical City, Riyadh, Saudi Arabia.
3. Associate Professor NCI, Cairo University Cairo, Egypt.
4. Consultant Neurosurgeon National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
5. Assistant Consultant, Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia.
6. Lecturer of Clinical Oncology, Sohag University, Sohag, Egypt.
7. Resident Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia.
Background: Linear accelerator (LINAC) based radiosurgery for a brain arteriovenous malformation (bAVM) is replacing gamma knife radiosurgery. We present clinical outcome, obliteration rates and predictor factors of treatment success following LINAC radiosurgery for bAVM which is not much addressed subject in Middle East.
Methods: 13 patients who underwent LINAC radiosurgery for brain arteriovenous malformations from November 2008 to November 2011 in our radiation oncology department were retrospectively analyzed. Recollection of demographic data, AVM and treatment characteristics along with clinical and radiographic follow up information was done by reviewing the electronic data base.
Results: All thirteen patients underwent stereotactic radiosurgery by linear accelerator based treatment delivery system (BrainLab) over three years. These included 7 males and 6 females, with median age of 22 years. Intracranial hemorrhage was a presenting feature in 7 (54 %) of patients. Prior embolization was done in 10 (77%) patients with 7 patients having more than once undergone this procedure. The location of AVM was superficial in 9 (70%) and deep in brain in 4 (30%) patients. The mean AVM score was 0.97 with 3 patients having AVM score ≥ 1 with mean Spetzler-Martin grade of 2.7 and 8 (62%) patients having grade 3 or more. Median follow up was 30 months. Mean dose delivered was 21.7 Gy in single fraction. Complete obliteration of AVM nidus was achieved in 9 (70%) patients while 4 patients (30%) had partial obliteration. Six patients (67 %) achieved complete obliteration among 9 who had AVM score of less than 1. Post radiosurgery neurological deficit occurred in only one patient in form of right temporal field loss.
Conclusions: Linear accelerator based radiosurgery is promising treatment option for brain AVMs in majority of cases with reasonable adverse effect profile.
Keywords: Linear accelerator, stereotactic radiosurgery, brain arteriovenous malformations, embolization