{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:37:28Z","timestamp":1783399048666,"version":"3.54.6"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>We evaluated risk factors associated with the development of adverse radiation effects (ARE) after stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVMs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>We evaluated 755 patients with AVM who underwent a single Gamma Knife SRS procedure with at least a 2-year minimum follow-up. Eighty-seven patients (12%) underwent previous resection and 128 (17%) had previous embolization. The median target volume was 3.6 mL (range, 0.1\u201326.3 mL). The median margin dose was 20 Gy (range, 13\u201327 Gy).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Fifty-five patients (7%) developed symptomatic ARE at a median follow-up of 75 months. The cumulative rates of symptomatic ARE were 3.2%, 5.8%, 6.7%, and 7.5% at 1, 2, 3, and 5 years, respectively. Factors associated with a higher rate of developing symptomatic ARE included larger AVM volume, higher margin dose, larger 12-Gy volume, higher Spetzler\u2013Martin grade, and higher radiosurgery-based score. The rates of developing symptomatic ARE were higher in the brain stem (22%) or thalamus (16%), compared with AVMs located in other brain locations (4%\u20138%). Nineteen patients (3%) sustained irreversible new neurological deficits related to ARE, and 1 patient died. The rates of irreversible symptomatic ARE were 0.8%, 1.9%, 2.1%, and 2.8% at 1, 2, 3, and 5 years, respectively. The 5-year cumulative rates of irreversible symptomatic ARE were 9.1% in thalamus, 12.1% in brain stem, and 1.4% in other locations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The knowledge of ARE risk rates after AVM radiosurgery can assist informed consent for patients with AVM, their families, and healthcare providers.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.116.014825","type":"journal-article","created":{"date-parts":[[2016,11,30]],"date-time":"2016-11-30T04:32:31Z","timestamp":1480480351000},"page":"84-90","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":89,"title":["Estimating the Risks of Adverse Radiation Effects After Gamma Knife Radiosurgery for Arteriovenous Malformations"],"prefix":"10.1161","volume":"48","author":[{"given":"Hideyuki","family":"Kano","sequence":"first","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tonetti","sequence":"additional","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Hsu","sequence":"additional","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huai-che","family":"Yang","sequence":"additional","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Flannery","sequence":"additional","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"From the Departments of Neurological Surgery (H.K., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (H.K., J.C.F., D.T., A.H., H.-c.Y., T.J.F., A.N., L.D.L.), University of Pittsburgh School of Medicine, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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