Stereotactic radiosurgery guideline for the management of patients with intracranial arteriovenous malformations.

Our objective was to provide guidelines about the use of stereotactic radiosurgery in symptomatic patients with imaging-identified arteriovenous malformations (AVMs) of the brain. We reviewed evidence-based medicine and clinical experience with radiosurgery for AVM of the brain to develop guidelines and provide scientific foundation for patients and physicians. Major recommendations include the definition of AVM patients suitable for various management strategies ranging from observation to surgical excision to endovascular embolization and stereotactic radiosurgery. The optimal dose range for volumetric conformal AVM stereotactic radiosurgery has been largely established based on location and volume of the AVM. The relationship to prior embolization or prior surgery has been evaluated. The role of repeat radiosurgery has been assessed for those patients with incomplete obliteration of their AVM after 3 years have elapsed. The causes of failure of stereotactic radiosurgery have also been identified. A clinical algorithm for the potential role of stereotactic radiosurgery for a symptomatic brain AVM was defined. The guidelines provide a framework for professional judgment and treatment selection alternatives.