{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T21:44:23Z","timestamp":1780350263764,"version":"3.54.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,5,26]]},"abstract":"\n BACKGROUND<\/jats:title>\n Cerebral arteriovenous malformations (AVMs) are complex vascular anomalies associated with significant risks of hemorrhage and neurological deficits. Stereotactic radiosurgery (SRS) has emerged as a viable treatment option, particularly for small, deep-seated, or eloquent lesions, offering a less invasive alternative to microsurgical resection. However, SRS carries risks, including radiation-induced complications such as radiation necrosis.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n This report describes the case of a 24-year-old male with a left temporal AVM, classified as Spetzler-Martin grade II, who underwent SRS with a marginal dose of 18 Gy. Over a 36-month follow-up period, complete obliteration of the AVM nidus was achieved. However, significant radiation-induced complications emerged, including vasogenic edema, radiation necrosis, memory deficits, partial seizures, and bilateral visual field defects. These complications peaked around 20 months post-SRS, requiring long-term management with corticosteroids, diuretics, and anticonvulsants.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case underscores the importance of balancing the benefits of AVM obliteration with the risks of radiation-induced injury. While SRS is effective for treating AVMs, particularly in high-risk locations, the potential for delayed complications highlights the need for careful patient selection, meticulous treatment planning, and long-term follow-up. The report also discusses the pathophysiology of radiation-induced necrosis, strategies to mitigate its risk, and the role of advanced imaging techniques in optimizing treatment planning.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25201<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25201","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T20:17:36Z","timestamp":1748290656000},"source":"Crossref","is-referenced-by-count":1,"title":["Long-term outcomes and radiation-induced complications following stereotactic radiosurgery for a left temporal arteriovenous malformation: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6745-5697","authenticated-orcid":true,"given":"Moustafa A.","family":"Mansour","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Nasser Institute for Research and Treatment, Cairo, Egypt"},{"name":"Neurosurgery Department, Mayo Clinic Foundation, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdel-Fattah","family":"El-Salamoni","sequence":"additional","affiliation":[{"name":"Department of Human Physiology and Basic Medical Sciences, Faculty of Medicine, Al-Azhar University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdi Nabawi","family":"Mostafa","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Nasser Institute for Research and Treatment, Cairo, Egypt"},{"name":"Department of Neurosurgery, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"bib1","series-title":"Radiol Case Rep","first-page":"6452","article-title":"Diagnostic and therapeutic dilemmas of asymptomatic intracranial AVMs: a case report and evidence-based review","volume":"19","author":"Mansour","year":"2024","unstructured":"Mansour MAMalaeb RWMostafa HNKamal MIAyoub B.Diagnostic and therapeutic dilemmas of asymptomatic intracranial AVMs: a case report and evidence-based review. Radiol Case Rep. 2024;19(12):6452-6459."},{"issue":"3","key":"bib2","series-title":"Cureus","article-title":"Unmasking a rare venous-predominant arteriovenous malformation: a case of recurrent subarachnoid hemorrhage successfully treated with stereotactic radiosurgery","volume":"17","author":"Mansour","year":"2025","unstructured":"Mansour MAMostafa HN.Unmasking a rare venous-predominant arteriovenous malformation: a case of recurrent subarachnoid hemorrhage successfully treated with stereotactic radiosurgery. Cureus. 2025;17(3):e80265."},{"issue":"4","key":"bib3","series-title":"J Neurosurg","first-page":"512","article-title":"Stereotactic radiosurgery for arteriovenous malformations of the brain","volume":"75","author":"Lunsford","year":"1991","unstructured":"Lunsford LDKondziolka DFlickinger JCStereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg. 1991;75(4):512-524."},{"issue":"6","key":"bib4","series-title":"Neurol India","first-page":"841","article-title":"Stereotactic radiosurgery for intracranial arteriovenous malformations: a review","volume":"63","author":"Moorthy","year":"2015","unstructured":"Moorthy RKRajshekhar V.Stereotactic radiosurgery for intracranial arteriovenous malformations: a review. Neurol India. 2015;63(6):841-851."},{"issue":"1","key":"bib5","series-title":"J Neurosurg Pediatr","first-page":"1","article-title":"Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes","volume":"14","author":"Potts","year":"2014","unstructured":"Potts MBSheth SALouie JStereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes. J Neurosurg Pediatr. 2014;14(1):1-11."},{"key":"bib6","series-title":"J Clin Neurosci","first-page":"30","article-title":"Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 1: brainstem arteriovenous malformations","volume":"24","author":"Cohen-Inbar","year":"2016","unstructured":"Cohen-Inbar ODing DChen CJSheehan JP.Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 1: brainstem arteriovenous malformations. J Clin Neurosci. 2016;24:30-36."},{"issue":"3","key":"bib7","series-title":"Neurosurgery","first-page":"442","article-title":"Stereotactic radiosurgery for Spetzler-Martin grade I and II arteriovenous malformations: International Society of Stereotactic Radiosurgery (ISRS) practice guideline","volume":"87","author":"Graffeo","year":"2020","unstructured":"Graffeo CSSahgal ADe Salles AStereotactic radiosurgery for Spetzler-Martin grade I and II arteriovenous malformations: International Society of Stereotactic Radiosurgery (ISRS) practice guideline. Neurosurgery. 2020;87(3):442-452."},{"issue":"18","key":"bib8","series-title":"JAMA","first-page":"2011","article-title":"Treatment of brain arteriovenous malformations: a systematic review and meta-analysis","volume":"306","author":"van Beijnum","year":"2011","unstructured":"van Beijnum Jvan der Worp HBBuis DRTreatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA. 2011;306(18):2011-2019."},{"key":"bib9","series-title":"World Neurosurg","first-page":"e992","article-title":"Stereotactic radio surgery, embolization and conservative management for cerebral arteriovenous malformation: a New Zealand experience of long-term outcomes","volume":"164","author":"Bethanabatla","year":"2022","unstructured":"Bethanabatla RSpencer TKelly LGan PTaha A.Stereotactic radio surgery, embolization and conservative management for cerebral arteriovenous malformation: a New Zealand experience of long-term outcomes. World Neurosurg. 2022;164:e992-e1000."},{"key":"bib10","series-title":"World Neurosurg","first-page":"e529","article-title":"Predictive factors for arteriovenous malformation obliteration after stereotactic radiosurgery: a single-center study","volume":"160","author":"Erickson","year":"2022","unstructured":"Erickson NMooney JSalehani APredictive factors for arteriovenous malformation obliteration after stereotactic radiosurgery: a single-center study. World Neurosurg. 2022;160:e529-e536."},{"key":"bib11","series-title":"Prog Neurol Surg","first-page":"130","article-title":"Stereotactic radiosurgery guideline for the management of patients with intracranial arteriovenous malformations","volume":"27","author":"Niranjan","year":"2013","unstructured":"Niranjan ALunsford LD.Stereotactic radiosurgery guideline for the management of patients with intracranial arteriovenous malformations. Prog Neurol Surg. 2013;27:130-140."},{"issue":"9","key":"bib12","series-title":"Biomedicines","first-page":"2003","article-title":"Considerations for the use of stereotactic radiosurgery to treat large arteriovenous malformations","volume":"12","author":"Lim","year":"2024","unstructured":"Lim JHKim MJ.Considerations for the use of stereotactic radiosurgery to treat large arteriovenous malformations. Biomedicines. 2024;12(9):2003."},{"issue":"4","key":"bib13","series-title":"Cureus","article-title":"Radiation necrosis in intracranial lesions","volume":"12","author":"Munier","year":"2020","unstructured":"Munier SGinalis EEPatel NVDanish SHanft S.Radiation necrosis in intracranial lesions. Cureus. 2020;12(4):e7603."},{"issue":"1","key":"bib14","series-title":"Neurol Med Chir (Tokyo)","first-page":"50","article-title":"Pathophysiology, diagnosis, and treatment of radiation necrosis in the brain","volume":"55","author":"Miyatake","year":"2015","unstructured":"Miyatake SINonoguchi NFuruse MPathophysiology, diagnosis, and treatment of radiation necrosis in the brain. Neurol Med Chir (Tokyo). 2015;55(1):50-59."},{"issue":"2","key":"bib15","series-title":"Curr Med Chem","first-page":"130","article-title":"Inflammation and chronic oxidative stress in radiation-induced late normal tissue injury: therapeutic implications","volume":"16","author":"Zhao","year":"2009","unstructured":"Zhao WRobbins ME.Inflammation and chronic oxidative stress in radiation-induced late normal tissue injury: therapeutic implications. Curr Med Chem. 2009;16(2):130-143."},{"issue":"2","key":"bib16","series-title":"J Neurosurg","first-page":"254","article-title":"Dose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations","volume":"99","author":"Barker","year":"2003","unstructured":"Barker FG2ndButler WELyons SDose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations. J Neurosurg. 2003;99(2):254-263."},{"issue":"5","key":"bib17","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1143","article-title":"Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group","volume":"46","author":"Flickinger","year":"2000","unstructured":"Flickinger JCKondziolka DLunsford LDDevelopment of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group. Int J Radiat Oncol Biol Phys. 2000;46(5):1143-1148."},{"issue":"1","key":"bib18","series-title":"J Neurosurg","first-page":"54","article-title":"Stereotactic radiosurgery for arteriovenous malformations, part 6: multistaged volumetric management of large arteriovenous malformations","volume":"116","author":"Kano","year":"2012","unstructured":"Kano HKondziolka DFlickinger JCStereotactic radiosurgery for arteriovenous malformations, part 6: multistaged volumetric management of large arteriovenous malformations. J Neurosurg. 2012;116(1):54-65."},{"issue":"5","key":"bib19","series-title":"Mayo Clin Proc","first-page":"1157","article-title":"The role of biological effective dose in predicting obliteration after stereotactic radiosurgery of cerebral arteriovenous malformations","volume":"96","author":"Nesvick","year":"2021","unstructured":"Nesvick CLGraffeo CSBrown PDThe role of biological effective dose in predicting obliteration after stereotactic radiosurgery of cerebral arteriovenous malformations. Mayo Clin Proc. 2021;96(5):1157-1164."},{"issue":"5","key":"bib20","series-title":"Neurosurgery","first-page":"850","article-title":"The use of hypofractionated radiosurgery for the treatment of intracranial lesions unsuitable for single-fraction radiosurgery","volume":"83","author":"Zhong","year":"2018","unstructured":"Zhong JPress RHOlson JJOyesiku NMShu HGEaton BR.The use of hypofractionated radiosurgery for the treatment of intracranial lesions unsuitable for single-fraction radiosurgery. Neurosurgery. 2018;83(5):850-857."},{"issue":"suppl 1","key":"bib21","series-title":"J Neurosurg","first-page":"139","article-title":"Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery","volume":"125","author":"Gavin","year":"2016","unstructured":"Gavin CGIan Sabin H.Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery. J Neurosurg. 2016;125(suppl 1):139-146."},{"issue":"5","key":"bib22","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1487","article-title":"Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system","volume":"79","author":"Levin","year":"2011","unstructured":"Levin VABidaut LHou PRandomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys. 2011;79(5):1487-1495."},{"issue":"12","key":"bib1","series-title":"Radiol Case Rep","first-page":"6452","article-title":"Diagnostic and therapeutic dilemmas of asymptomatic intracranial AVMs: a case report and evidence-based review","volume":"19","author":"Mansour","year":"2024","unstructured":"Mansour MAMalaeb RWMostafa HNKamal MIAyoub B.Diagnostic and therapeutic dilemmas of asymptomatic intracranial AVMs: a case report and evidence-based review. Radiol Case Rep. 2024;19(12):6452-6459."},{"issue":"3","key":"bib2","series-title":"Cureus","article-title":"Unmasking a rare venous-predominant arteriovenous malformation: a case of recurrent subarachnoid hemorrhage successfully treated with stereotactic radiosurgery","volume":"17","author":"Mansour","year":"2025","unstructured":"Mansour MAMostafa HN.Unmasking a rare venous-predominant arteriovenous malformation: a case of recurrent subarachnoid hemorrhage successfully treated with stereotactic radiosurgery. Cureus. 2025;17(3):e80265."},{"issue":"4","key":"bib3","series-title":"J Neurosurg","first-page":"512","article-title":"Stereotactic radiosurgery for arteriovenous malformations of the brain","volume":"75","author":"Lunsford","year":"1991","unstructured":"Lunsford LDKondziolka DFlickinger JCStereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg. 1991;75(4):512-524."},{"issue":"6","key":"bib4","series-title":"Neurol India","first-page":"841","article-title":"Stereotactic radiosurgery for intracranial arteriovenous malformations: a review","volume":"63","author":"Moorthy","year":"2015","unstructured":"Moorthy RKRajshekhar V.Stereotactic radiosurgery for intracranial arteriovenous malformations: a review. Neurol India. 2015;63(6):841-851."},{"issue":"1","key":"bib5","series-title":"J Neurosurg Pediatr","first-page":"1","article-title":"Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes","volume":"14","author":"Potts","year":"2014","unstructured":"Potts MBSheth SALouie JStereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes. J Neurosurg Pediatr. 2014;14(1):1-11."},{"key":"bib6","series-title":"J Clin Neurosci","first-page":"30","article-title":"Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 1: brainstem arteriovenous malformations","volume":"24","author":"Cohen-Inbar","year":"2016","unstructured":"Cohen-Inbar ODing DChen CJSheehan JP.Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 1: brainstem arteriovenous malformations. J Clin Neurosci. 2016;24:30-36."},{"issue":"3","key":"bib7","series-title":"Neurosurgery","first-page":"442","article-title":"Stereotactic radiosurgery for Spetzler-Martin grade I and II arteriovenous malformations: International Society of Stereotactic Radiosurgery (ISRS) practice guideline","volume":"87","author":"Graffeo","year":"2020","unstructured":"Graffeo CSSahgal ADe Salles AStereotactic radiosurgery for Spetzler-Martin grade I and II arteriovenous malformations: International Society of Stereotactic Radiosurgery (ISRS) practice guideline. Neurosurgery. 2020;87(3):442-452."},{"issue":"18","key":"bib8","series-title":"JAMA","first-page":"2011","article-title":"Treatment of brain arteriovenous malformations: a systematic review and meta-analysis","volume":"306","author":"van Beijnum","year":"2011","unstructured":"van Beijnum Jvan der Worp HBBuis DRTreatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA. 2011;306(18):2011-2019."},{"key":"bib9","series-title":"World Neurosurg","first-page":"e992","article-title":"Stereotactic radio surgery, embolization and conservative management for cerebral arteriovenous malformation: a New Zealand experience of long-term outcomes","volume":"164","author":"Bethanabatla","year":"2022","unstructured":"Bethanabatla RSpencer TKelly LGan PTaha A.Stereotactic radio surgery, embolization and conservative management for cerebral arteriovenous malformation: a New Zealand experience of long-term outcomes. World Neurosurg. 2022;164:e992-e1000."},{"key":"bib10","series-title":"World Neurosurg","first-page":"e529","article-title":"Predictive factors for arteriovenous malformation obliteration after stereotactic radiosurgery: a single-center study","volume":"160","author":"Erickson","year":"2022","unstructured":"Erickson NMooney JSalehani APredictive factors for arteriovenous malformation obliteration after stereotactic radiosurgery: a single-center study. World Neurosurg. 2022;160:e529-e536."},{"key":"bib11","series-title":"Prog Neurol Surg","first-page":"130","article-title":"Stereotactic radiosurgery guideline for the management of patients with intracranial arteriovenous malformations","volume":"27","author":"Niranjan","year":"2013","unstructured":"Niranjan ALunsford LD.Stereotactic radiosurgery guideline for the management of patients with intracranial arteriovenous malformations. Prog Neurol Surg. 2013;27:130-140."},{"issue":"9","key":"bib12","series-title":"Biomedicines","first-page":"2003","article-title":"Considerations for the use of stereotactic radiosurgery to treat large arteriovenous malformations","volume":"12","author":"Lim","year":"2024","unstructured":"Lim JHKim MJ.Considerations for the use of stereotactic radiosurgery to treat large arteriovenous malformations. Biomedicines. 2024;12(9):2003."},{"issue":"4","key":"bib13","series-title":"Cureus","article-title":"Radiation necrosis in intracranial lesions","volume":"12","author":"Munier","year":"2020","unstructured":"Munier SGinalis EEPatel NVDanish SHanft S.Radiation necrosis in intracranial lesions. Cureus. 2020;12(4):e7603."},{"issue":"1","key":"bib14","series-title":"Neurol Med Chir (Tokyo)","first-page":"50","article-title":"Pathophysiology, diagnosis, and treatment of radiation necrosis in the brain","volume":"55","author":"Miyatake","year":"2015","unstructured":"Miyatake SINonoguchi NFuruse MPathophysiology, diagnosis, and treatment of radiation necrosis in the brain. Neurol Med Chir (Tokyo). 2015;55(1):50-59."},{"issue":"2","key":"bib15","series-title":"Curr Med Chem","first-page":"130","article-title":"Inflammation and chronic oxidative stress in radiation-induced late normal tissue injury: therapeutic implications","volume":"16","author":"Zhao","year":"2009","unstructured":"Zhao WRobbins ME.Inflammation and chronic oxidative stress in radiation-induced late normal tissue injury: therapeutic implications. Curr Med Chem. 2009;16(2):130-143."},{"issue":"2","key":"bib16","series-title":"J Neurosurg","first-page":"254","article-title":"Dose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations","volume":"99","author":"Barker","year":"2003","unstructured":"Barker FG2ndButler WELyons SDose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations. J Neurosurg. 2003;99(2):254-263."},{"issue":"5","key":"bib17","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1143","article-title":"Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group","volume":"46","author":"Flickinger","year":"2000","unstructured":"Flickinger JCKondziolka DLunsford LDDevelopment of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group. Int J Radiat Oncol Biol Phys. 2000;46(5):1143-1148."},{"issue":"1","key":"bib18","series-title":"J Neurosurg","first-page":"54","article-title":"Stereotactic radiosurgery for arteriovenous malformations, part 6: multistaged volumetric management of large arteriovenous malformations","volume":"116","author":"Kano","year":"2012","unstructured":"Kano HKondziolka DFlickinger JCStereotactic radiosurgery for arteriovenous malformations, part 6: multistaged volumetric management of large arteriovenous malformations. J Neurosurg. 2012;116(1):54-65."},{"issue":"5","key":"bib19","series-title":"Mayo Clin Proc","first-page":"1157","article-title":"The role of biological effective dose in predicting obliteration after stereotactic radiosurgery of cerebral arteriovenous malformations","volume":"96","author":"Nesvick","year":"2021","unstructured":"Nesvick CLGraffeo CSBrown PDThe role of biological effective dose in predicting obliteration after stereotactic radiosurgery of cerebral arteriovenous malformations. Mayo Clin Proc. 2021;96(5):1157-1164."},{"issue":"5","key":"bib20","series-title":"Neurosurgery","first-page":"850","article-title":"The use of hypofractionated radiosurgery for the treatment of intracranial lesions unsuitable for single-fraction radiosurgery","volume":"83","author":"Zhong","year":"2018","unstructured":"Zhong JPress RHOlson JJOyesiku NMShu HGEaton BR.The use of hypofractionated radiosurgery for the treatment of intracranial lesions unsuitable for single-fraction radiosurgery. Neurosurgery. 2018;83(5):850-857."},{"issue":"suppl 1","key":"bib21","series-title":"J Neurosurg","first-page":"139","article-title":"Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery","volume":"125","author":"Gavin","year":"2016","unstructured":"Gavin CGIan Sabin H.Stereotactic diffusion tensor imaging tractography for Gamma Knife radiosurgery. J Neurosurg. 2016;125(suppl 1):139-146."},{"issue":"5","key":"bib22","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1487","article-title":"Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system","volume":"79","author":"Levin","year":"2011","unstructured":"Levin VABidaut LHou PRandomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. 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