malformations of the brain: influencing factors and evolution with time. Stroke 2012; 43:1247. 72. Lunsford LD, Kondziolka D, Flickinger JC, et al. Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 1991; 75:512. 73. Ogilvy CS. Radiation therapy for arteriovenous malformations: a review. Neurosurgery 1990; 26:725. 74. Fabrikant JI, Levy RP, Steinberg GK, et al. Stereotactic charged-particle radiosurgery: clinical results of treatment of 1200 patients with intracranial arteriovenous malformations and pituitary disorders. Clin Neurosurg 1992; 38:472. 75. Skj th-Rasmussen J, Roed H, Ohlhues L, et al. Complications following linear accelerator based stereotactic radiation for cerebral arteriovenous malformations. Int J Radiat Oncol Biol Phys 2010; 77:542. 76. Friedman WA, Bova FJ, Bollampally S, Bradshaw P. Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery 2003; 52:296. 77. Zipfel GJ, Bradshaw P, Bova FJ, Friedman WA. Do the morphological characteristics of arteriovenous malformations affect the results of radiosurgery? J Neurosurg 2004; 101:393. https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 24/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate 78. Foote KD, Friedman WA, Ellis TL, et al. Salvage retreatment after failure of radiosurgery in patients with arteriovenous malformations. J Neurosurg 2003; 98:337. 79. Pollock BE, Meyer FB. Radiosurgery for arteriovenous malformations. J Neurosurg 2004; 101:390. 80. Flickinger JC, Pollock BE, Kondziolka D, Lunsford LD. A dose-response analysis of arteriovenous malformation obliteration after radiosurgery. Int J Radiat Oncol Biol Phys 1996; 36:873. 81. Karlsson B, Lindquist C, Steiner L. Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 1997; 40:425. 82. Maruyama K, Koga T, Niranjan A, et al. Radiosurgery for brainstem arteriovenous malformation. Prog Neurol Surg 2013; 27:67. 83. Hauswald H, Milker-Zabel S, Sterzing F, et al. Repeated linac-based radiosurgery in high- grade cerebral arteriovenous-malformations (AVM) Spetzler-Martin grade III to IV previously treated with radiosurgery. Radiother Oncol 2011; 98:217. 84. Flickinger JC, Kondziolka D, Lunsford LD, et al. A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys 1999; 44:67. 85. Ding D, Yen CP, Xu Z, et al. Radiosurgery for patients with unruptured intracranial arteriovenous malformations. J Neurosurg 2013; 118:958. 86. Yang SY, Kim DG, Chung HT, Paek SH. Radiosurgery for unruptured cerebral arteriovenous malformations: long-term seizure outcome. Neurology 2012; 78:1292. 87. Chen CJ, Ding D, Kumar JS, et al. Hemorrhage and Recurrence of Obliterated Brain Arteriovenous Malformations Treated With Stereotactic Radiosurgery. Stroke 2022; 53:e363. 88. Flickinger JC, Kondziolka D, Lunsford LD, et al. Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group. Int J Radiat Oncol Biol Phys 2000; 46:1143. 89. Pollock BE, Gorman DA, Brown PD. Radiosurgery for arteriovenous malformations of the basal ganglia, thalamus, and brainstem. J Neurosurg 2004; 100:210. 90. Miyawaki L, Dowd C, Wara W, et al. Five year results of LINAC radiosurgery for arteriovenous malformations: outcome for large AVMS. Int J Radiat Oncol Biol Phys 1999; 44:1089. 91. Buis DR, Meijer OW, van den Berg R, et al. Clinical outcome after repeated radiosurgery for brain arteriovenous malformations. Radiother Oncol 2010; 95:250. https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 25/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate 92. Blonder LX, Hodes JE, Ranseen JD, Schmitt FA. Short-term neuropsychological outcome following Gamma Knife radiosurgery for arteriovenous malformations: a preliminary report. Appl Neuropsychol 1999; 6:181. 93. Raymond J, Gentric JC, Magro E, et al. Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2023; 138:1393. 94. Krings T, Hans FJ, Geibprasert S, Terbrugge K. Partial "targeted" embolisation of brain arteriovenous malformations. Eur Radiol 2010; 20:2723. 95. Brown RD Jr, Flemming KD, Meyer FB, et al. Natural history, evaluation, and management of intracranial vascular malformations. Mayo Clin Proc 2005; 80:269. 96. Kano H, Kondziolka D, Flickinger JC, et al. Stereotactic radiosurgery for arteriovenous malformations after embolization: a case-control study. J Neurosurg 2012; 117:265. 97. Schwyzer L, Yen CP, Evans A, et al. Long-term results of gamma knife surgery for partially embolized arteriovenous malformations. Neurosurgery 2012; 71:1139. 98. Starke RM, Kano H, Ding D, et al. Stereotactic radiosurgery for cerebral arteriovenous malformations: evaluation of long-term outcomes in a multicenter cohort. J Neurosurg 2017; 126:36. 99. Ding D, Starke RM, Kano H, et al. Stereotactic radiosurgery for Spetzler-Martin Grade III arteriovenous malformations: an international multicenter study. J Neurosurg 2017; 126:859. 100. Cohen-Inbar O, Lee CC, Xu Z, et al. A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations. J Neurosurg 2015; 123:945. 101. Starke RM, Komotar RJ, Otten ML, et al. Adjuvant embolization with N-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations: outcomes, complications, and predictors of neurologic deficits. Stroke 2009; 40:2783. 102. Hartmann A, Pile-Spellman J, Stapf C, et al. Risk of endovascular treatment of brain arteriovenous malformations. Stroke 2002; 33:1816. 103. Copelan A, Drocton G, Caton MT, et al. Brain Arteriovenous Malformation Recurrence After Apparent Microsurgical Cure: Increased Risk in Children Who Present With Arteriovenous Malformation Rupture. Stroke 2020; 51:2990. 104. Saleh RS, Singhal A, Lohan D, et al. Assessment of cerebral arteriovenous malformations with high temporal and spatial resolution contrast-enhanced magnetic resonance https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 26/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate angiography: a review from protocol to clinical application. Top Magn Reson Imaging 2008; 19:251. Topic 1087 Version 37.0 https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 27/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate GRAPHICS Cerebellar hematoma due to ruptured AVM (A) Noncontrast head CT showing acute right cerebellar ICH with smaller adjacent focus of hemorrhage (black arrow). (B) Subsequent FLAIR sequence on brain MRI after decompressive craniectomy showing flow void (white arrow) adjacent to ICH (white dashed arrow). (C) Digital subtraction angiogram subsequently identified an AVM with a nidus (white arrowhead), feeding artery (white thick arrow), and draining vein (white short arrow). CT: computed tomography; ICH: intracerebral hemorrhage; FLAIR: fluid-attenuated inversion recovery; MRI: magnetic resonance imaging; AVM: arteriovenous malformation. Courtesy of Glenn A Tung, MD, FACR. Graphic 132273 Version 1.0 https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 28/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate MRI of brain arteriovenous malformation T2-weighted MRI of the brain demonstrates multiple flow voids in the right hemisphere, suggestive of a large arteriovenous malformation. MRI: magnetic resonance imaging. From: Flemming KD, Lanzino G. Management of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations. Continuum (Minneap Minn) 2017; 23:181. DOI: 10.1212/CON.0000000000000418. Copyright 2017 American Academy of Neurology. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited. Graphic 53992 Version 6.0 https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 29/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate Brain arteriovenous malformation pretreatment angiography Characteristic angiographic appearance of a brain arteriovenous malformation (AVM) before therapy. Courtesy of Guy Rordorf, MD. Graphic 75190 Version 2.0 https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 30/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate Brain arteriovenous malformation posttreatment angiography Angiogram obtained after the brain arteriovenous malformation (AVM) seen in the prior radiograph was treated. Courtesy of Guy Rordorf, MD. Graphic 62349 Version 2.0 https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 31/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate Spetzler-Martin grading scale for intracranial arteriovenous malformations Score Size 0 to 3 cm 1 3.1 to 6.0 cm 2 >6 cm 3 Location Noneloquent brain area 0 Eloquent brain area* 1 Deep venous drainage Absent 0 Present 1 Score = sum of all categories, with lesions graded 1 to 5 based upon total sum (eg, 1 point = grade 1). Associated with significant neurologic impairment (eg, language area, motor cortex, others). Reference: 1. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65:476. Graphic 71261 Version 4.0 https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 32/33 7/5/23, 12:18 PM Brain arteriovenous malformations - UpToDate Contributor Disclosures Robert J Singer, MD No relevant financial relationship(s) with ineligible companies to disclose. Christopher S Ogilvy, MD Consultant/Advisory Boards: Cerevasc [Hydrocephalus]; Contour [Aneurysms]; Medtronic [Chronic subdural hematoma]. All of the relevant financial relationships listed have been mitigated. Guy Rordorf, MD No relevant financial relationship(s) with ineligible companies to disclose. Jos Biller, MD, FACP, FAAN, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Richard P Goddeau, Jr, DO, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/brain-arteriovenous-malformations/print 33/33