LAUSR

Radiation necrosis (RN) is a well described complication seen after stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVM). First-line medical therapies are not always successful in alleviating symptoms and management of some cases may require open surgical resection of the lesion. Surgery is often thought of however as a last resort given its associated morbidity especially in the setting of potential concern for residual live AVM. Magnetic resonance imaging (MRI)-guided laser interstitial thermotherapy (LITT) is a minimally invasive surgical procedure that is being increasingly considered for RN lesions and is best established for treatment of symptomatic RN that can develop after stereotactic radiosurgical treatment of metastatic brain tumors. Its ability to treat RN from other primary pathologies remains unclear. Here, we present 2 cases that show successful use of LITT in patients with biopsy-confirmed RN post-radiosurgery for AVMs. As with tumor-associated RN, LITT can result in rapid improvement of symptoms related to reduction in perilesional edema and then shrinkage and eventual stabilization of the RN lesion.