{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T20:04:33Z","timestamp":1772913873800,"version":"3.50.1"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,1]]},"abstract":"\nObject<\/jats:title>\nIn this paper, the authors' goal was to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the medulla, pons, and midbrain.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nBetween 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 67 patients had AVMs in the brainstem. In this series, 51 patients (76%) had a prior hemorrhage. The median target volume was 1.4 cm3<\/jats:sup> (range 0.1\u201313.4 cm3<\/jats:sup>). The median margin dose was 20 Gy (range 14\u201325.6 Gy).<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nObliteration of the AVMs was eventually documented in 35 patients at a median follow-up of 73 months (range 6\u2013269 months). The actuarial rates of documentation of total obliteration were 41%, 70%, 70%, and 76% at 3, 4, 5, and 10 years, respectively. Higher rates of AVM obliteration were associated only with a higher margin dose. Four patients (6%) suffered a hemorrhage during the latency period, and 2 patients died. The rate of AVM hemorrhage after SRS was 3.0%, 3.0%, and 5.8% at 1, 5, and 10 years, respectively. The overall annual hemorrhage rate was 1.9%. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 7 patients (10%) after SRS, and a delayed cyst developed in 2 patients (3%). One patient died at an outside institution with symptoms of AREs and unrecognized hydrocephalus. Higher 12-Gy volumes and higher Spetzler-Martin grades were associated with a higher risk of symptomatic AREs. Ten of 22 patients who had ocular dysfunction before SRS had improvement, 9 were unchanged, and 3 were worse due to AREs. Eight of 14 patients who had hemiparesis before SRS improved, 5 were unchanged, and 1 was worse.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nAlthough hemorrhage after obliteration did not occur in this series, patients remained at risk during the latency interval until obliteration occurred. Thirty-eight percent of the patients who had neurological deficits due to prior hemorrhage improved. Higher dose delivery in association with conformal and highly selective SRS is required for safe and effective radiosurgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.9.jns11176","type":"journal-article","created":{"date-parts":[[2011,11,11]],"date-time":"2011-11-11T15:08:32Z","timestamp":1321024112000},"page":"44-53","source":"Crossref","is-referenced-by-count":56,"title":["Stereotactic radiosurgery for arteriovenous malformations, Part 5: management of brainstem arteriovenous malformations"],"prefix":"10.3171","volume":"116","author":[{"given":"Hideyuki","family":"Kano","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology, and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huai-che","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"},{"name":"Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Flannery","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Novotny","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology, and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns11176","series-title":"Neurosurgery","first-page":"56","article-title":"Radiosurgery for basal ganglia, internal capsule, and thalamus arteriovenous malformation: clinical outcome","volume":"56","author":"Andrade-Souza","year":"2005"},{"key":"b2-jns11176","series-title":"Stroke","first-page":"2794","article-title":"A population-based study of brain arteriovenous malformation: long-term treatment outcomes","volume":"33","author":"ApSimon","year":"2002"},{"key":"b3-jns11176","series-title":"J Neurosurg","first-page":"849","article-title":"Arteriovenous malformations of the posterior fossa. Clinical presentation, diagnostic evaluation, and surgical treatment","volume":"64","author":"Batjer","year":"1986"},{"key":"b4-jns11176","series-title":"J Neurosurg","first-page":"29","article-title":"Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: a population-based study of intracranial vascular malformations in Olmsted Country, Minnesota","volume":"85","author":"Brown","year":"1996"},{"key":"b5-jns11176","series-title":"J Neurosurg","first-page":"1","article-title":"Posterior fossa arteriovenous malformations","volume":"64","author":"Drake","year":"1986"},{"key":"b6-jns11176","series-title":"Int J Radiat Oncol Biol Phys","first-page":"67","article-title":"A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery","volume":"44","author":"Flickinger","year":"1999"},{"key":"b7-jns11176","series-title":"N Engl J Med","first-page":"2704","article-title":"Clinical practice. 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Arteriovenous malformations An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the cooperative study","volume":"25","author":"Perret","year":"1966"},{"key":"b23-jns11176","series-title":"Neurosurgery","first-page":"259","article-title":"Management of cysts arising after radiosurgery to treat intracranial arteriovenous malformations","volume":"49","author":"Pollock","year":"2001"},{"key":"b24-jns11176","series-title":"J Neurosurg","first-page":"79","article-title":"A proposed radiosurgery-based grading system for arteriovenous malformations","volume":"96","author":"Pollock","year":"2002"},{"key":"b25-jns11176","series-title":"Neurosurgery","first-page":"1239","article-title":"Factors associated with successful arteriovenous malformation radiosurgery","volume":"42","author":"Pollock","year":"1998"},{"key":"b26-jns11176","series-title":"J Neurosurg","first-page":"210","article-title":"Radiosurgery for arteriovenous malformations of the basal ganglia, thalamus, and brainstem","volume":"100","author":"Pollock","year":"2004"},{"key":"b27-jns11176","series-title":"J Neurosurg","first-page":"1044","article-title":"Magnetic resonance imaging: an accurate method to evaluate arteriovenous malformations after stereotactic radiosurgery","volume":"85","author":"Pollock","year":"1996"},{"key":"b28-jns11176","series-title":"J Neurosurg","first-page":"857","article-title":"Management of arteriovenous malformations of the brain stem","volume":"64","author":"Solomon","year":"1986"},{"key":"b29-jns11176","series-title":"J Neurosurg","first-page":"476","article-title":"A proposed grading system for arteriovenous malformations","volume":"65","author":"Spetzler","year":"1986"},{"key":"b30-jns11176","series-title":"Stroke","first-page":"920","article-title":"Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presentation","volume":"33","author":"Stefani","year":"2002"},{"key":"b31-jns11176","series-title":"Surg Neurol","first-page":"327","article-title":"Total removal of an arteriovenous malformation embedded in the brain stem","volume":"34","author":"Sugiura","year":"1990"},{"key":"b32-jns11176","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1147","article-title":"A modified radiosurgery-based arteriovenous malformation grading scale and its correlation with outcomes","volume":"79","author":"Wegner","year":"2011"},{"key":"b33-jns11176","series-title":"Neurosurgery","first-page":"906","article-title":"Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation","volume":"38","author":"Yamamoto","year":"1996"},{"key":"b34-jns11176","series-title":"Microneurosurgery","first-page":"358","article-title":"Infratentorial (central) AVMs","volume":"Vol IIIB","year":"1987"},{"key":"b35-jns11176","series-title":"Neurosurgery","first-page":"443","article-title":"Total removal of a brain stem arteriovenous malformation: case report","volume":"13","author":"Yonekawa","year":"1983"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/1\/article-p44.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/1\/article-p44.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/1\/article-p44.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T01:29:36Z","timestamp":1679880576000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/1\/article-p44.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,1]]},"references-count":35,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2011.9.jns11176","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,1]]}}}