{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:50:20Z","timestamp":1789195820208,"version":"build-2803163510"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Ruptured intracranial arteriovenous malformations (AVMs) are at a significantly greater risk for future hemorrhage than unruptured lesions, thereby necessitating treatment in the majority of cases. In a retrospective, single-center study, the authors describe the outcomes after radiosurgery in a large cohort of patients with ruptured AVMs.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>From an institutional review board\u2013approved, prospectively collected AVM radiosurgery database, the authors identified all patients with a history of AVM rupture. They analyzed obliteration rates in all patients in whom radiological follow-up data were available (n = 639). However, to account for the latency period associated with radiosurgery, only those patients with more than 2 years of radiological follow-up and those with earlier AMV obliteration were included in the analysis of prognostic factors related to obliteration and complications. This resulted in a cohort of 565 patients with ruptured AVMs for whom data were analyzed; these patients had a median radiological follow-up of 57 months and a median age of 29 years. Twenty-one percent of the patients underwent preradiosurgery embolization. The median volume and prescription dose were 2.1 cm<jats:sup>3<\/jats:sup> and 22 Gy, respectively. The Spetzler-Martin grade was III or higher in 56% of patients, the median radiosurgery-based AVM score was 1.08, and the Virginia Radiosurgery AVM Scale (RAS) score was 3 to 4 points in 44%. Survival and regression analyses were performed to determine obliteration rates over time and predictors of obliteration and complications.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In the overall population of 639 patients with ruptured AVMs, the obliteration rate was 11.1% based on MRI only (71 of 639 patients), 56.0% based on angiography (358 of 639), and 67.1% based on combined modalities (429 of 639 patients). In the cohort of patients with 2 years of follow-up or an earlier AVM obliteration, the cumulative obliteration rate was 76% and the actuarial obliteration rates were 41% and 64% at 3 and 5 years, respectively. Multivariate analysis identified the absence of preradiosurgery embolization (p &lt; 0.001), increased prescription dose (p = 0.001), the presence of a single draining vein (p = 0.046), no postradiosurgery-related hemorrhage (p = 0.007), and lower Virginia RAS score (p = 0.020) as independent predictors of obliteration. The annual risk of a hemorrhage occurring during the latency period was 2.0% and the rate of hemorrhage-related morbidity and mortality was 1.6%. Multivariate analysis showed that decreased prescription dose (p &lt; 0.001) and multiple draining veins (p = 0.003) were independent predictors of postradiosurgery hemorrhage. The rates of symptomatic and permanent radiation-induced changes were 8% and 2.7%, respectively. In the multivariate analysis, a single draining vein (p &lt; 0.001) and higher Virginia RAS score (p = 0.005) were independent predictors of radiation-induced changes following radiosurgery.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Radiosurgery effectively treats ruptured AVMs with an acceptably low risk-to-benefit ratio. For patients with ruptured AVMs, favorable outcomes are more likely when preradiosurgical embolization is avoided and a higher prescription dose can be delivered.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.2.jns131605","type":"journal-article","created":{"date-parts":[[2014,3,21]],"date-time":"2014-03-21T14:33:56Z","timestamp":1395412436000},"page":"470-481","source":"Crossref","is-referenced-by-count":91,"title":["Radiosurgery for ruptured intracranial arteriovenous malformations"],"prefix":"10.3171","volume":"121","author":[{"given":"Dale","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Starke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Sheehan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1-jns131605","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.3171\/2009.2.FOCUS0926","article-title":"Pathogenesis and radiobiology of brain arteriovenous malformations: implications for risk stratification in natural history and posttreatment course","volume":"26","author":"Achrol","year":"2009"},{"key":"b2-jns131605","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1227\/01.NEU.0000255347.25959.D0","article-title":"Embolization before radiosurgery reduces the obliteration rate of arteriovenous malformations","volume":"60","author":"Andrade-Souza","year":"2007"},{"key":"b3-jns131605","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"320","DOI":"10.3174\/ajnr.A2943","article-title":"Liquid embolization material reduces the delivered radiation dose: clinical myth or reality?","volume":"33","author":"Bing","year":"2012"},{"key":"b4-jns131605","series-title":"Clin Neuropathol","first-page":"111","article-title":"Stereotactic radiosurgery of arteriovenous malformations: pathologic changes in resected tissue","volume":"16","author":"Chang","year":"1997"},{"key":"b5-jns131605","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1161\/01.STR.0000217970.18319.7d","article-title":"Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation","volume":"37","author":"Choi","year":"2006"},{"key":"b6-jns131605","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/S1474-4422(05)70073-9","article-title":"Brain arteriovenous malformations in adults","volume":"4","author":"Choi","year":"2005"},{"key":"b7-jns131605","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3310","DOI":"10.1161\/STROKEAHA.107.504613","article-title":"Unruptured brain arteriovenous malformations should be treated conservatively: no","volume":"38","author":"Cockroft","year":"2007"},{"key":"b8-jns131605","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1161\/STROKEAHA.108.524678","article-title":"The natural history and predictive features of hemorrhage from brain arteriovenous malformations","volume":"40","author":"da Costa","year":"2009"},{"key":"b9-jns131605","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3312","DOI":"10.1161\/STROKEAHA.107.504621","article-title":"Unruptured brain arteriovenous malformations: another asymptomatic conundrum","volume":"38","author":"Davis","year":"2007"},{"key":"b10-jns131605","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"958","DOI":"10.3171\/2013.2.JNS121239","article-title":"Radiosurgery for patients with unruptured intracranial arteriovenous malformations. 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