Radiosurgery of Cerebral Arteriovenous Malformations: is an Early Angiogram Needed?

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 1999 Apr 29

PMID 10219415

Citations 12

Authors

C Oppenheim

J F Meder

D Trystram

F Nataf

S Godon-Hardy

J Blustajn

L Merienne

M Schlienger

D Fredy

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Radiosurgical treatment of arteriovenous malformations (AVMs) has slow and progressive vasoocclusive effects. We sought to determine if early posttherapeutic angiography provides relevant information for the management of radiosurgically treated AVMs.

Methods: Between 1990 and 1993, the progress of 138 of 197 cerebral AVMs treated by linear accelerator (Linac) was regularly followed by angiographic study. On each posttherapeutic angiogram ("early," 6-18-month follow-up; "intermediate," 19-29-month-follow-up; and "late," > 30-month follow-up), the degree of reduction across the greatest diameter of the nidus and hemodynamic modifications were analyzed. Each cerebral AVM was qualitatively classified into one of the following categories after early angiographic study: 0%-reduced, 25%-reduced, 50%-reduced, 75%-reduced, and 100%-reduced or "complete obliteration." Vasoocclusive progress for each category was then studied over time.

Results: Three (10%) of the 30 0-25%-reduced, eight (38%) of 21 50%-reduced, and 27 (84%) of 32 75%-reduced cerebral AVMs showed complete obliteration after further follow-up. The three 0-25%-reduced AVMS that went on to complete obliteration underwent very early angiography (6-7 months). Fifty-five cerebral AVMs showed complete obliteration on early angiograms (40%). In this group, more follow-up, when performed, confirmed complete obliteration in all cases (n = 17).

Conclusion: An early angiogram is needed to predict the effectiveness of radiosurgery. Important AVM changes seen on early angiograms are highly correlated with treatment success. Moreover, no or minor changes seen on early angiograms are highly predictive of radiosurgical failure. For these patients, further treatment should be discussed promptly.

Citing Articles

DSA Quantitative Analysis and Predictive Modeling of Obliteration in Cerebral AVM following Stereotactic Radiosurgery.

Jabal M, Mohammed M, Nesvick C, Kobeissi H, Graffeo C, Pollock B AJNR Am J Neuroradiol. 2024; 45(10):1521-1527.

PMID: 39266257 PMC: 11448972. DOI: 10.3174/ajnr.A8351.

Four-dimensional digital subtraction angiography for the vascular anatomical diagnosis of dural arteriovenous malformation: Comparison with the conventional method.

Ishikawa K, Nishihori M, Izumi T, Oshima R, Uemura T, Kanamori F Interv Neuroradiol. 2022; 30(5):738-745.

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Artificial Intelligence-Based 3D Angiography for Visualization of Complex Cerebrovascular Pathologies.

Lang S, Hoelter P, Schmidt M, Strother C, Kaethner C, Kowarschik M AJNR Am J Neuroradiol. 2021; 42(10):1762-1768.

PMID: 34503946 PMC: 8562747. DOI: 10.3174/ajnr.A7252.

Magnetic Resonance Imaging-Based Robotic Radiosurgery of Arteriovenous Malformations.

Greve T, Ehret F, Hofmann T, Thorsteinsdottir J, Dorn F, Svigelj V Front Oncol. 2021; 10:608750.

PMID: 33767974 PMC: 7986716. DOI: 10.3389/fonc.2020.608750.

Susceptibility-Weighted Angiography for the Follow-Up of Brain Arteriovenous Malformations Treated with Stereotactic Radiosurgery.

Finitsis S, Anxionnat R, Gory B, Planel S, Liao L, Bracard S AJNR Am J Neuroradiol. 2019; 40(5):792-797.

PMID: 31023658 PMC: 7053887. DOI: 10.3174/ajnr.A6053.

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