Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Radiosurgery Society Case-Based Guideline.

[PURPOSE] Brain arteriovenous malformations (AVMs) are high-risk vascular anomalies associated with hemorrhage, neurological morbidity, and mortality. Stereotactic radiosurgery (SRS) is a well-established, non-invasive treatment that achieves durable obliteration while preserving neurological function. This case-based guideline summarizes contemporary SRS-based AVM management and outcomes.

[METHODS AND MATERIALS] Three illustrative cases were selected: a small, unruptured Spetzler-Martin grade (SMG) I AVM treated with single-fraction SRS, a large SMG V AVM managed with volume-staged SRS, and a ruptured SMG II AVM treated with embolization followed by definitive SRS.

[RESULTS] Single-fraction SRS achieves durable obliteration for small AVMs, while staged approaches allow safe treatment of large or complex lesions and complement microsurgery and embolization. Treatment planning emphasizes integration of advanced imaging, precise nidus delineation, and dose-volume optimization. Long-term surveillance remains essential to confirm obliteration and detect delayed complications.

[CONCLUSION] This case-based guideline highlights practical principles of SRS for brain AVM management, emphasizing individualized selection, multidisciplinary collaboration, and meticulous planning to optimize safety and efficacy.