Angiographic Follow-up of One-Stage Radiosurgery for Multiple Cerebral Arteriovenous Malformations

Because multiple cerebral arteriovenous malformations (AVMs) are extremely rare, little information is available as to stereotactic radiosurgery for multiple AVMs. We present a patient with three cerebral AVMs who underwent one stage gamma knife radiosurgery for all three nidi. Each nidus was covered with a 90% isodose volume and a central dose of 27.8 Gy was used to obtain a marginal dose of 25 Gy. Angiography that was performed 10 months after irradiation demonstrated complete obliteration in one nidus, remarkable shrinkage in another and no significant changes in the other. The patient has experienced neither bleeding nor complications related to irradiation, to date. We consider one of the major benefits of stereotactic radiosurgery to be that multiple intracranial AVMs, if all nidi are sufficiently small (<3 cm), can be treated with a single procedure.