El-Salamoni, Mohamed Abdel-Fattah

BACKGROUND Cerebral arteriovenous malformations (AVMs) are complex vascular anomalies associated with significant risks of hemorrhage and neurological deficits. Stereotactic radiosurgery (SRS) has emerged as a viable treatment option, particularly for small, deep-seated, or eloquent lesions, offering a less invasive alternative to microsurgical resection. However, SRS carries risks, including radiation-induced complications such as radiation necrosis. OBSERVATIONS This report describes the case of a 24-year-old male with a left temporal AVM, classified as Spetzler-Martin grade II, who underwent SRS with a marginal dose of 18 Gy. Over a 36-month follow-up period, complete obliteration of the AVM nidus was achieved. However, significant radiation-induced complications emerged, including vasogenic edema, radiation necrosis, memory deficits, partial seizures, and bilateral visual field defects. These complications peaked around 20 months post-SRS, requiring long-term management with corticosteroids, diuretics, and anticonvulsants. LESSONS This case underscores the importance of balancing the benefits of AVM obliteration with the risks of radiation-induced injury. While SRS is effective for treating AVMs, particularly in high-risk locations, the potential for delayed complications highlights the need for careful patient selection, meticulous treatment planning, and long-term follow-up. The report also discusses the pathophysiology of radiation-induced necrosis, strategies to mitigate its risk, and the role of advanced imaging techniques in optimizing treatment planning. https://thejns.org/doi/10.3171/CASE25201