{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T20:14:07Z","timestamp":1785615247345,"version":"3.56.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Cerebral arteriovenous malformations (AVMs) are challenging lesions, often requiring multimodal interventions; however, data on the efficacy of stereotactic radiosurgery for cerebral AVMs are limited. This study aimed to evaluate the clinical and radiographic results following robotic radiosurgery, alone or in combination with endovascular treatment, and to investigate factors associated with obliteration and complications in patients with AVM.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We retrospectively analyzed the clinical and imaging characteristics of 123 patients with AVMs of all Spetzler-Martin grades treated at two institutions by robotic radiosurgery in single-fraction doses (CyberKnife). Embolization was performed before radiosurgery in a subset of patients to attempt to downgrade the lesions. Factors associated with AVM obliteration and complications (toxicity) were identified via univariate and multivariate analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The median follow-up time was 48.1 months (range, 3.6\u2013123 months). Five patients were lost to follow-up. The obliteration rate in the 59 patients with a follow-up period exceeding four years was 72.8%. Complete obliteration and partial remission were achieved in 67 (56.8%) and 31 (26.3%) cases, respectively, whereas no change was observed in 20 cases (17.8%). Embolization was performed in 54\/123 cases (43.9%). Complete and partial obliteration were achieved in 29 (55.7%) and 14 (26.9%) embolized patients, respectively. In the multivariate analysis, the factors associated with obliteration were age (p = .018) and the Spetzler-Martin grade (p = .041). Treatment-induced toxicity (radiation necrosis and\/or edema) was observed in 15 cases (12.7%), rebleeding occurred in three cases (2.5%), and the rate of mortality associated with rebleeding was 1.7%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>CyberKnife radiosurgery is a valid approach for treating AVMs of all Spetzler-Martin-grades, with satisfactory obliteration rates, low toxicity, and a relatively rare incidence of rebleeding.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0266744","type":"journal-article","created":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T18:05:14Z","timestamp":1663869914000},"page":"e0266744","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Image-guided robotic radiosurgery for the treatment of arteriovenous malformations"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3986-9243","authenticated-orcid":true,"given":"Franziska","family":"Loebel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pontoriero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Kluge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Iat\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gueliz","family":"Acker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kufeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Cacciola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Pergolizzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7443-8270","authenticated-orcid":true,"given":"Sergio","family":"Vinci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Stromberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Budach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Senger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9408-2662","authenticated-orcid":true,"given":"Alfredo","family":"Conti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,22]]},"reference":[{"issue":"5","key":"pone.0266744.ref001","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/2009.2.FOCUS09316","article-title":"Cerebral arteriovenous malformations. Part 1: cellular and molecular biology","volume":"26","author":"P. Moftakhar","year":"2009","journal-title":"Neurosurg Focus"},{"issue":"5","key":"pone.0266744.ref002","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1227\/01.NEU.0000330401.82582.5E","article-title":"Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients","volume":"63","author":"J.A. Hernesniemi","year":"2008","journal-title":"Neurosurgery"},{"key":"pone.0266744.ref003","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/B978-0-444-63640-9.00002-3","article-title":"The natural history of cerebral arteriovenous malformations","volume":"143","author":"A. Can","year":"2017","journal-title":"Handb Clin Neurol"},{"issue":"6","key":"pone.0266744.ref004","first-page":"543mr","article-title":"Brain arteriovenous malformations","volume":"82","author":"A.R. Ferrara","year":"2011","journal-title":"Radiol Technol"},{"issue":"4","key":"pone.0266744.ref005","first-page":"761","article-title":"Classification of AVMs","volume":"83","author":"J.J. Morcos","year":"1995","journal-title":"J Neurosurg"},{"issue":"2","key":"pone.0266744.ref006","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.1227\/01.NEU.0000312703.46158.54","article-title":"Cyberknife image-guided radiosurgery","volume":"64","author":"J.R. Adler","year":"2009","journal-title":"Neurosurgery"},{"key":"pone.0266744.ref007","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jocn.2018.10.109","article-title":"Long-term follow up data on difficult to treat intracranial arteriovenous malformations treated with the CyberKnife","volume":"61","author":"R. Gupta","year":"2019","journal-title":"J Clin Neurosci"},{"issue":"4","key":"pone.0266744.ref008","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3171\/2008.10.JNS08749","article-title":"Early results of CyberKnife radiosurgery for arteriovenous malformations","volume":"111","author":"F. Colombo","year":"2009","journal-title":"J Neurosurg"},{"issue":"1\u20134","key":"pone.0266744.ref009","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1159\/000099863","article-title":"The Cyberknife: a frameless robotic system for radiosurgery","volume":"69","author":"J.R. Adler","year":"1997","journal-title":"Stereotact Funct Neurosurg"},{"key":"pone.0266744.ref010","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40064-015-0804-2","article-title":"CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations","volume":"4","author":"A. Conti","year":"2015","journal-title":"Springerplus"},{"issue":"5","key":"pone.0266744.ref011","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2009.8.FOCUS09-157","article-title":"Protecting venous structures during radiosurgery for parasagittal meningiomas","volume":"27","author":"A. Conti","year":"2009","journal-title":"Neurosurg Focus"},{"issue":"5","key":"pone.0266744.ref012","first-page":"e605","article-title":"Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication","volume":"8","author":"A. Conti","year":"2016","journal-title":"Cureus"},{"issue":"11","key":"pone.0266744.ref013","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2176\/nmc.38.780","article-title":"Clinical experience with image-guided robotic radiosurgery (the Cyberknife) in the treatment of brain and spinal cord tumors","volume":"38","author":"S.D. 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Yen","year":"2013","journal-title":"Prog Neurol Surg"},{"issue":"36","key":"pone.0266744.ref028","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.3346\/jkms.2019.34.e232","article-title":"Gamma Knife Radiosurgery for ARUBA-Eligible Patients with Unruptured Brain Arteriovenous Malformations","volume":"34","author":"B.S. Kim","year":"2019","journal-title":"J Korean Med Sci"},{"key":"pone.0266744.ref029","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.wneu.2019.05.160","article-title":"\"ARUBA\" Aftermath: Subsequent Studies and Current Management of Unruptured Arteriovenous Malformations","volume":"128","author":"J. Feghali","year":"2019","journal-title":"World Neurosurg"},{"issue":"5","key":"pone.0266744.ref030","doi-asserted-by":"crossref","first-page":"635","DOI":"10.3109\/02688697.2015.1096909","article-title":"Time for BARBADOS after ARUBA trial","volume":"29","author":"M. Teo","year":"2015","journal-title":"Br J Neurosurg"},{"issue":"9917","key":"pone.0266744.ref031","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/S0140-6736(13)62302-8","article-title":"Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial","volume":"383","author":"J.P. Mohr","year":"2014","journal-title":"Lancet"},{"issue":"Suppl","key":"pone.0266744.ref032","doi-asserted-by":"crossref","first-page":"58","DOI":"10.3171\/sup.2006.105.7.58","article-title":"Treatment of arteriovenous malformations with linear accelerator-based radiosurgery compared with Gamma Knife surgery","volume":"105","author":"P. Orio","year":"2006","journal-title":"J Neurosurg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266744","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T18:06:12Z","timestamp":1663869972000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266744"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,9,22]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0266744","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,22]]}}}