Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2020;16(1):20-25.
Published online June 30, 2020.
Preliminary Result of Gamma Knife Radiosurgery (GKRS) for Arteriovenous Malformation (AVM): Above 20Gy Marginal Dose Versus Below 18Gy Marginal Dose
Ha-Young Choi, Eun Jeong Koh
Department of Neurosurgery, School of Medicine, Jeonbuk National University, Jeonbuk National University Hospital, Jeonju, Korea
The aims of this study were to analyze outcome after Gamma Knife stereotactic radiosurgery (GKRS) and to know the affecting factors to obliterate arteriovenous malformation (AVM) via GKRS monotherapy. We investigated whether marginal dose above 20Gy and below 18Gy lead to different outcomes.
For this study, we included 24 patients with AVM who underwent GKRS monotherapy between May 2006 and July 2016. Patients's age, gender, symptom grade, AVM location, number of feeding arteries, number of draining veins, AVM density, nidus volume, Spetzler-Martin grade, Virginia radiosurgery AVM scale (VRAS), radiosurgery-based AVM score (RBAS), marginal dose, shot number, and final AVM status were all retrospectively analyzed.
The mean follow-up period was 65.35 months (30-140 months). The overall complete obliteration rate was 87.5% (21/24). In a multiple regression test nidus volume (p=0.009) was the only statistically significant factor related to AVM obliteration across all patients. Symptom grade (p=0.031), nidus volume (p=0.019), and RBAS (p=0.009) were statistically significant between the high-dose (>20Gy) and low-dose (<18Gy) treatment groups according to Mann-Whitney test results. The <18Gy marginal-dose group showed a tendency toward lower symptom grade, larger nidus volume, and higher RBAS than the >20Gy marginal-dose group.
We conclude that physicians can perform GKRS with a <18Gy-marginal dose rather than the commonly used high marginal dose (>20Gy) to avoid adverse radiation effects (ARE) in cases with relatively large volumes and low symptom grades. Relatively low-dose planning can yield satisfactory results for AVM obliteration without hemorrhagic complications or adverse radiation effects (ARE).
Key Words: Arteriovenous malformation, Gamma Knife radiosurgery, Marginal dose, Adverse radiation effect.

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