FACTORS INFLUENCING THE RISK FOR COMPLICATIONS FOLLOWING GAMMA-KNIFE RADIOSURGERY OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS

Background and purpose: We reported previously a model predicting the risk for radiation-induced complications following Gamma Knife radiosu rgery for AVM. No factor other than the dose distribution was related to the risk. The aim of this study was to define if other parameters a re of importance for the risk of complications. Material and methods: The model above was used to calculate the risk for complications in al l 1128 AVM patients Gamma Knife-treated at the Karolinska Hospital 197 0-1993. The number of predicted complications was compared to the numb er of observed ones for a number of different parameters. Results: The model underestimated the risk of complications for patients previousl y given radiation with multiple or single fractions. Neither age nor g ender influenced the risk of complications. Centrally located AVM had a higher, and peripheral a lower incidence of complications as compare d to the calculated risk, and a previous hemorrhage reduced the risk o f complications. From the observed number of complications, parameters in the model were determined by a fitting procedure separately for th ree groups of AVM: central and peripheral with and without a previous hemorrhage. It is also shown that the assumption of a serial functiona l architecture is valid in the model. This was investigated by the use of a relative seriality model with a combined serial-parallel functio nal architecture. Conclusions: The risk of complications following rad iosurgical treatment of AVM is dependent on the clinical history, AVM location and whether the patient has received radiation earlier. (C) 1 997 Elsevier Science Ireland Ltd.