The Outcome of Patients with Cerebral Arteriovenous Malformations (AVMs) Treated with Stereotactic Radiosurgery (SRS) Using the CyberKnife (Rationale, Benefits and Risks): A Real-World Experience

Background: Cerebral arteriovenous malformations (AVMs) are complex, heterogeneous, uncommon lesions that carry a high risk of intracranial hemorrhage with subsequent disability. Aim: To evaluate the outcome of patients with cerebral AVMs treated in our center, King Faisal Specialized Hospital and Research Center (KFSH&RC) Saudi Arabia with SRS using the CyberKnife. Methods: Medical records of patients treated in the above-mentioned way in the period between 2009-2021 were retrospectively evaluated. Results: A total of 51 patients were included in this study. The median age at diagnosis was 31 (3-77) years. Neurological alteration and intracranial hemorrhage were the most common presentations in 24 (47.1%) patients. The mean maximum AVM nidus diameter and volume were 2.9 cm and 5.9 cc respectively. All the patients received SRS using CyberKnife with a median marginal dose of 20 (14-21) Gy over a single fraction. Volume staged treatment was applied in 4 (7.8%) patients. After a median follow-up of 37 (2-170) months, all patients were alive with successful obliteration of the AVM nidus occurring in 31 (60.8%) patients after a median latency period of 27 (4-68.9) months in those who achieved complete obliteration. No patients developed post-SRS hemorrhage and 11 (21.6%) patients developed post-SRS radiological radiation-induced changes of which only 3 (27.3%) patients were symptomatic (in the form of uncontrolled seizures). only SRS dose > 19 Gy was significantly correlated with the obliteration rate, as 79.3% of patients who received SRS dose > 19 Gy achieved obliteration vs 36.4 % only in those who received dose Conclusion: SRS treatment using CyberKnife is effective management for patients with cerebral AVMs without an increase in the incidence of post-SRS hemorrhage, stroke, or death.