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Les malformations arterio-veineuses ou angiomes cerebraux sont des anomalies vasculaires congenitales qui se definissent par la presence d’un shunt arterio-veineux anormal. Materiels et methodes: Nous avons mene une etude retrospective entre Janvier 1992 et Decembre 2010 au service de radiochirurgie de l’hopital de la Timone, 1557 patients ont ete traites par radiochirurgie pour une malformation arterioveineuse dont 61 patients pour une localisation du tronc cerebral (3.91%). Resultats: L’âge moyen de 35.8-/+16.6 ans (4-75).16 patients avaient beneficie d’une embolisation preradiochirurgicale (26.23%). Le mode de decouverte etait une hemorragie pour 53 patients (87%). Le volume moyen de traitement etait de 1.43+/-1.96 cm 3 (0.09-14.20). Le score RBAS etait en moyenne de 1.36 +/- 0.34 (0.64-2.35). La dose moyenne de prescription a l’enveloppe l’isodose 50% delivree etait de 22.9 +/-2.9 Gy (12-30), la dose mediane etait de 24 Gy).Notre taux d’obliteration global apres une ou deux procedures etait de 67.27%, pour un delai moyen de suivi est de 56.7 mois+/-43.3 (8.1-251.7). Les facteurs en rapport avec une obliteration) : score RBAS bas (p=0.012), une dose de traitement superieur a 20Gy (p=0.034). Nous avons eu une mortalite de 1.63% et un pourcentage de saignement apres la procedure de 6.55% et 3.2% deficits neurologiques radio-induits. Conclusion: La radiochirurgie est maintenant devenue incontournable dans le traitement des malformations du tronc cerebral meme s’il existe un risque hemorragique persistant jusqu’a la guerison (3.5%). Le taux d’obliteration complete est de 67.27% Mots cles: malformations arterio-veineuses, tronc cerebral, radiochirurugie English Title:  Stereotactic radiosurgery for brainstem arteriovenous malformations English Abstract Introduction: Arterioveinous malformations (AVM) or cerebral angiomas are congenital vascular abnormalities which are defined by the presence of abnormal arterio-veinous shunt. Methods:  We lead a retrospective study recruiting 1557 patients treated between January 1992 and December 2010 in the Radiosurgery Unit of La Timone hospital in Marseille. All patients received radiosurgery for management of an AVM, 61 of them being brainstem AVMs (3.91%). Results: Mean age was 35.8 +/- 16.6 years. Sixteen patients underwent arterial embolization before surgery (26.23%). Hemorrhage was the primary onset for 53 patients (87%). Mean volume before treatment was 1.43+/-1.96 cm 3 (0.09-14.20). Average RBAS score was 1.36 +/-0.34 (0.64-2.35). Average prescripted dose for 50% delivered iso-dose was 22.9 +/-2.9 Gy (12-30), mean dose was 24 Gy. Our global occlusion rate after one or two treatments was 67.27%, considering an average follow-up of 56.7 months +/- 43.3 (8.1- 251.7). Occlusion related factors were: low RBAS score (p=0.012), received dose higher than 20Gy (p=0.034). Our death rate was 1.63% and our post-procedure bleeding rate was 6.55% with 3.2% of neurological post-procedure deficience. Conclusion: Having regard of remaining hemorrhage risk until complete recovery (3.5%), radiosurgery is nonetheless now a key treatment in the management brainstem AVMS. Complete occlusion rate in our study was 67.27%. Keywords: arteriovenous malformations, brainstem, radiosurgery

Radiochirurgie des malformations arterio-veineuses du tronc cerebral stereotactic radiosurgery for brainstem arteriovenous malformations