Seizure control after radiosurgical treatment in patients with cerebral arteriovenous malformations: An observational study

OBJECTIVE: Seizures are among the most common symptoms of cerebral arteriovenous malformations (AVMs). Although the main goal of AVM treatment remains complete obliteration, seizure control has become an important treatment aspect in recent years. Thus, we analyzed seizure control following Gamma Knife Radiosurgery (GKRS) treatment at our department in patients with AVMs. METHODS: We analyzed 130 patients with AVMs who had at least one seizure before treatment with GKRS at our tertiary referral center between 1992 and 2022. We analyzed predictors for treatment success, including AVM size, Virginia Radiosurgery AVM Scale, Radiosurgery-Based AVM Score, Spetzler-Ponce class, Spetzler-Martin grade, localization, and identified independent predictors of seizure persistence. RESULTS: Median follow-up was 9.7 years. Improved seizure control was documented for 89% of patients. Seizure-free status after radiosurgery was achieved for 78% of patients. Spetzler-Ponce class C (odds ratio [OR] = 4.6) and having multiple seizures before the first GKRS treatment (OR = 3.5) were independent predictors for seizure persistence. Still, 72% of patients with multiple seizures prior to AVM treatment were seizure-free at last follow-up. Among patients with multiple seizures, having a high-grade AVM was identified as an independent predictor of seizure persistence (OR = 12.1). SIGNIFICANCE: GKRS, as a stand-alone management option or in combination with endovascular therapy, is an effective treatment option in AVM management, not only to achieve AVM obliteration but also to control AVM-related seizures. The Spetzler-Ponce class is a powerful predictor of seizure persistence at last follow-up, especially in patients with multiple seizures prior to treatment.