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Arteriovenous malformations (AVM) are uncommon congenital abnormalities with a prevalence of 10-18 per 100, 000 adults (Al-Shahi et al. 2002; Berman et al. 2000) and an incidence of 1. 3 per 100, 000 person-years. (Stapf et al. 2003) Arteriovenous malformations typically present with hemorrhage, seizure, or focal neurological deficit. Intracranial hemorrhage is the most common clinical presentation of an AVM, resulting in significant morbidity and mortality. The natural risk of primary hemorrhage in untreated AVMs is 2% to 4% per year. (Barrow and Reisner 1993; Brown et al. 1988; Crawford et al. 1986; Davis and Symon 1985; Forster, Steiner, and Hakanson 1972; Fults and Kelly 1984; Graf, Perret, and Torner 1983; Mast et al. 1997; Ondra et al. 1990; Pollock et al. 1996) The primary goal of AVM treatment is elimination of the risk of hemorrhage by removal of the bleeding potential of the abnormal vasculature. Currently, the therapeutic options for AVM treatment include microsurgical resection, stereotactic radiosurgery (SRS), and endovascular embolization, alone or in combination. Small AVMs or those that are surgically inaccessible in deep brain or eloquent cortex are typically amenable to stereotactic radiosurgery.

Hemorrhage from Arteriovenous Malformation Following Gamma Knife Radiosurgery: Pathophysiology of Rupture Early in the Latency Period