BACKGROUND AND OBJECTIVES: Studies comparing neurological and radiographic outcomes of repeat to initial stereotactic radiosurgery (SRS) intracranial arteriovenous malformations are scarce. Our aim was to perform a retrospective matched comparison of patients initially treated with SRS with those undergoing a second radiosurgical procedure. METHODS: We collected data from arteriovenous malformations managed in 21 centers that underwent initial and repeated radiosurgery from 1987 to 2022. Based on arteriovenous malformations volume, margin dose, deep venous drainage, deep, and critical location, we matched 1:1 patients who underwent an initial SRS for treatment-naive arteriovenous malformations and a group with repeated SRS treatment. RESULTS: After the selection process, our sample consisted of 328 patients in each group. Obliteration in the initial SRs group was 35.8% at 3 and 56.7% at 5 years post-SRS, while the repeat SRS group showed obliteration rates of 33.9% at 3 years and 58.6% at 5 years, without statistically significant differences (P = .75 and P = .88, respectively). There were no statistically significant differences between the 2 groups for obliteration rates (hazard ratio = 0.93; 95% CI, 0.77-1.13; P = .5), overall radiation-induced changes (RIC) (OR = 1.1; 95% CI, 0.75-1.6; P = .6), symptomatic RIC (OR = 0.78; 95% CI, 0.4-1.5; P = .4), and post-SRS hemorrhage (OR = 0.68; 95% CI; P = .3). CONCLUSION: In matched cohort analysis, a second SRS provides comparable outcomes in obliteration and RIC compared with the initial SRS. Dose reduction on repeat SRS may not be warranted.

Department of Neurological Surgery University of Virginia Charlottesville Virginia USA

Department of Neurosurgery Benha University Benha Egypt

Department of Neurosurgery Cleveland Clinic Foundation Cleveland Ohio USA

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery Neurological Institute Taipei Veteran General Hospital Taipei City Taiwan

Department of Neurosurgery NYU Langone New York New York USA

Department of Neurosurgery Penn State Milton S Hershey Medical Center Hershey Pennsylvania USA

Department of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Neurosurgery University of Louisville Louisville Kentucky USA

Department of Neurosurgery University of Miami Miami Florida USA

Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania USA

Department of Neurosurgery University of Pittsburgh Pittsburgh Pennsylvania USA

Department of Neurosurgery University of Puerto Rico San Juan Puerto Rico USA

Department of Neurosurgery University of Sherbrooke Sherbrooke Quebec Canada

Department of Neurosurgery University of Southern California Los Angeles California USA

Department of Neurosurgery West Virginia University Morgantown West Virginia USA

Department of Radiation Oncology The James Comprehensive Cancer Center Ohio State University Columbus Ohio USA

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Gamma Knife Center Beaumont Health System Royal Oak Michigan USA

Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt

Radiosurgery Unit Hospital Ruber Internacional Madrid Spain

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