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Embolization before Gamma Knife radiosurgery for cerebral arteriovenous malformations does not negatively impact its obliteration rate: a series of 190 patients

  • Interventional Neuroradiology
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Embolization of arteriovenous malformations (AVMs) before radiosurgery has been reported to negatively impact the obliteration rate. This study aims to assess treatment outcomes in a series of 190 patients treated by Gamma Knife radiosurgery (GKRS) for previously embolized AVMs.


The institutional database of AVMs was retrospectively reviewed between January 2004 and March 2018. The clinical and radiological data of patients treated with GKRS for previously embolized AVMs were analyzed. Predicting factors of obliteration and hemorrhage following GKRS were assessed with univariate and multivariate regression analyses.


The mean AVM size was significantly reduced after embolization (p < 0.001). The obliteration rate was 78.4%. Multivariate analyses showed that a lower Spetzler-Martin grade (p = 0.035) and a higher marginal dose (p = 0.007) were associated with obliteration. Post-GKRS hemorrhages occurred in 14 patients (7.4%). A longer time between diagnosis and GKRS was the only factor associated with post-GKRS hemorrhages in multivariate analysis (p = 0.022). Complications related to the combined treatment were responsible for a new permanent neurological disability in 20 patients (10.5%), and a case of death (0.5%).


This study shows that the embolization of AVMs does not have a negative impact on the obliteration rate after radiosurgery. Embolization reduces the AVM size to a treatable volume by GKRS. However, the combined treatment results in an increased complication rate related to the addition of the risks of each treatment modality.

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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mehdi Yahia-Cherif, Chifra Fenton, Florence Lefranc and Boris Lubicz. The first draft of themanuscript was written by Mehdi Yahia-Cherif and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mehdi Yahia-Cherif.

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The authors declare no competing interests.

Ethics approval

The study obtained institutional ethics committee approval. Ethics committee ULB-Erasme.

Number: P2022/078.

Consent to participate

This retrospective study was approved by the institutional ethics committee approval, and patients’ consents were waived.

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This retrospective study was approved by the institutional ethics committee approval, and patients’ consents were waived.

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Yahia-Cherif, M., Fenton, C., Bonnet, T. et al. Embolization before Gamma Knife radiosurgery for cerebral arteriovenous malformations does not negatively impact its obliteration rate: a series of 190 patients. Neuroradiology 65, 391–399 (2023).

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