Surgery

Arteriovenous malformation

Cerebral angiography

Gamma knife

Radiation therapy

Radiology

Radiosurgery

Thermodynamics

Physics

Homogeneous

Intracranial Arteriovenous Malformations

Medicine

Nuclear medicine

Angiography

Stereotactic and Functional Neurosurgery

We have treated over 400 patients with symptomatic inoperable intracranial arteriovenous malformations (AVMs) with stereotactic heavy-charged-particle Bragg peak radiosurgery at the University of California at Berkeley in a collaborative program with Stanford University Medical Center and the University of California Medical Center, San Francisco. A long-term dose-searching clinical trial protocol has been developed and we have followed more than 250 patients for more than 2 years. Initially, radiation doses ranged from 45 to 35 GyE, and now doses of 25, 20, 15 and, under special circumstances, 10 GyE, depending on a number of factors, are being evaluated. The characteristics of charged-particle beams provide a relatively homogeneous dose distribution with the 90% isodose contour to the periphery of the lesion. When the entire arterial phase of the AVM core is included in the treatment field, the rates for complete obliteration 3 years after treatment are: 90–95% for volumes ≤4 cm3; 90–95% for volumes > 4 and ≤14 cm3; and 60–70% for volumes > 14 cm3. The total obliteration rate for all volumes up to 70 cm3 is approximately 80–85%. For complete radiation-induced obliteration there is a relationship of dose and volume primarily, and location secondarily. Results on relationships between dose, AVM obliteration, and complications and sequelae of the radiosurgical procedure are presented and discussed.

Heavy-Charged-Particle Radiosurgery for Intracranial Arteriovenous Malformations