Arteriovenous malformations (AVM) are quite rare, but they are dangerous pathology due to the risk of rupture and intracranial hemorrhage, which leads to disability. This review enlights the epidemiology of AVM and their symptoms, current methods of diagnostics and treatment as well as prognosis and treatment outcomes. Nowadays microsurgical removal, endovascular embolization, stereotactic radiosurgery and combination of these methods are used in clinical practice for AVMs treatment. Stereotactic radiosurgery is a highly effective non-invasive technique resulting in high degree of AVM obliteration with low risk of complications. The results of magnetic resonance imaging usage in assessing the degree of obliteration and the development of post-radiation complications are presented in this article. The optimization of magnetic resonance imaging algorithm is necessary for determination of statistically significant factors affecting the obliteration process.
Arteriovenous malformations (AVMs) of the brain are quite rare vascular pathologies, but they are life-threatening, due to the risk of intracerebral hemorrhage. Stereotactic radiosurgical treatment of patients with cerebral AVM is performed in cases where surgical removal is impossible or embolization with a stable occlusive effect cannot be performed. Currently, for the diagnosis of AVM, magnetic resonance imaging (MRI) is increasingly used because of its noninvasiveness and minimal risks. When a malformation is located in a functionally significant area, then a non-invasive technique is used to assess its interposition and mapping - functional magnetic resonance imaging.We have presented the experience of radiosurgical treatment of a 43-year-old male patient with a ruptured AVM located in the left temporal lobe, near Wernicke’s area. The patient underwent stereotactic radiosurgical treatment with Elekta Leksell Gamma Knife Perfection device, taking into account the location of the AVM in a functionally significant area, preoperative mapping was performed. After two years, according to MR angiography, the arterial component in the projection of the irradiated AVM was not visualized, which was confirmed by the data of cerebral angiography. Thus, a clinical example has demonstrated the high efficiency of MRI in the diagnosis and assessment of the results of the performed stereotactic radiosurgical treatment of AVMs.
Approximately 30% of patients with symptomatic epilepsy have pharmacoresistant seizures refractory to medical therapy. The most effective treatment modality is microsurgical resection of whole epileptogenic zone, not only visible on MRI lesion. However, in some cases patients still have seizures after operation. We provide a method of simultaneous EEG-fMRI to more accurate localization of epileptogenic zone after failed surgery. Here we present our experience of gamma knife stereotactic radiosurgery for patient harboring mesial temporal lobe epilepsy using EEG-fMRI for confirmation of residual epileptogenic zone.
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