Changes in AVM angio-architecture and hemodynamics after stereotactic radiosurgery assessed by dynamic MRA and phase contrast flow assessments

Schuster, L.; Schenk, Eric A.; Giesel, Frederik L.; Hauser, Thomas; Gerigk, Lars; Zabel-Du-Bois, A.; Essig, Marco

doi:10.1007/s00330-010-2031-0

Cited by 19 publications

(10 citation statements)

References 32 publications

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“…Neither the length of follow-up nor AVM obliteration was statistically associated with this neurological improvement, although we attributed the beneficial effects to modifications in AVM hemodynamics, leading to a reduced steal effect on the cerebral circulation. 25 Adverse effects of radiation traditionally represented a key problem in the radiosurgical management of large cerebral AVMs. Adverse radiation effects have been associated with a large nidus and a higher margin dose, among other factors.…”

Section: Discussionmentioning

confidence: 99%

Results of volume-staged fractionated Gamma Knife radiosurgery for large complex arteriovenous malformations: obliteration rates and clinical outcomes of an evolving treatment paradigm

Franzin

Panni

Spatola

et al. 2016

JNS

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OBJECTIVEThere are few reported series regarding volume-staged Gamma Knife radiosurgery (GKRS) for the treatment of large, complex, cerebral arteriovenous malformations (AVMs). The object of this study was to report the results of using volume-staged Gamma Knife radiosurgery for patients affected by large and complex AVMs.METHODSData from 20 patients with large AVMs were prospectively included in the authors' AVM database between 2004 and 2012. A staging strategy was used when treating lesion volumes larger than 10 cm3. Hemorrhage and seizures were the presenting clinical feature for 6 (30%) and 8 (40%) patients, respectively. The median AVM volume was 15.9 cm3 (range 10.1–34.3 cm3). The mean interval between stages (± standard deviation) was 15 months (± 9 months). The median margin dose for each stage was 20 Gy (range 18–25 Gy).RESULTSObliteration was confirmed in 8 (42%) patients after a mean follow-up of 45 months (range 19–87 months). A significant reduction (> 75%) of the original nidal volume was achieved in 4 (20%) patients. Engel Class I–II seizure status was reported by 75% of patients presenting with seizures (50% Engel Class I and 25% Engel Class II) after radiosurgery. After radiosurgery, 71.5% (5/7) of patients who had presented with a worsening neurological deficit reported a complete resolution or amelioration. None of the patients who presented acutely because of hemorrhage experienced a new bleeding episode during follow-up. One (5%) patient developed radionecrosis that caused sensorimotor hemisyndrome. Two (10%) patients sustained a bleeding episode after GKRS, although only 1 (5%) was symptomatic. High nidal flow rate and a time interval between stages of less than 11.7 months were factors significantly associated with AVM obliteration (p = 0.021 and p = 0.041, respectively). Patient age younger than 44 years was significantly associated with a greater than 75% reduction in AVM volume but not with AVM obliteration (p = 0.024).CONCLUSIONSAccording to the results of this study, volume-staged GKRS is an effective and safe treatment strategy for large, complex, cerebral AVMs for which microsurgery or endovascular approaches could carry substantially higher risks to the patient. Radiation doses up to 20 Gy can be safely administered. The time interval between stages should be shorter than 11.7 months to increase the chance of obliteration. High nidal flow and a patient age younger than 44 years were factors associated with nidus obliteration and significant nidus reduction, respectively.

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Section: Discussionmentioning

confidence: 99%

Results of volume-staged fractionated Gamma Knife radiosurgery for large complex arteriovenous malformations: obliteration rates and clinical outcomes of an evolving treatment paradigm

Franzin

Panni

Spatola

et al. 2016

JNS

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“…The aim of radiosurgery using either a gamma knife (GK) or an adapted linear accelerator (LINAC) is not to remove, but to obliterate CCMs, thereby, reducing the risk of rebleeding [34,35,36].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic LINAC radiosurgery for the treatment of brainstem cavernomas

et al. 2012

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“…Of these, 25 had supratentorial location with large and medium volume (>3.5cc, volume=π xyz /6, where x , y , and z represent the diameter of each axis on angiography). 6 Patients were further subdivided into 16 with no pathological evidence of hemosiderin (SIM-) and 9 with hemosiderin in or around the bAVM (SIM+). Hemosiderin positivity was based on a 5-point grading scale ranging from 0 to 4, where 0 indicates no hemosiderin and 1 through 4 indicates the presence of hemosiderin.…”

Section: Methodsmentioning

confidence: 99%

Higher Flow Is Present in Unruptured Arteriovenous Malformations With Silent Intralesional Microhemorrhages

Chen

Cooke

Saloner

et al. 2017

Stroke

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Background and Purpose Silent microhemorrhage (hemosiderin) has been observed in resected brain arteriovenous malformations (bAVM) tissue, and may represent a subgroup at increased risk for clinical hemorrhage. Previous studies suggest that ruptured bAVMs have faster flow and shorter mean transit time (MTT) of contrast in blood vessels than unruptured bAVMs. We hypothesized that flow would be faster in unruptured AVMs with hemosiderin compared to those without hemosiderin. Methods We selected unruptured, supratentorial bAVMs >3.5cc with pathology specimens. Hemodynamic features were evaluated using color-coding angiography, including contrast MTT of AVM nidus, time to peak (TTP) of feeding artery (FA) and draining vein (DV), and the ratio (TTP DV/FA). Characteristics of 9 cases with hemosiderin and 16 without hemosiderin were compared using two-sample t-tests and Fisher’s exact tests. Results No difference in FA TTP and DV TTP was observed between groups. However, cases with hemosiderin had significantly shorter MTT compared to those without hemosiderin (1.11 ± 0.28 seconds versus 1.64 ± 0.55; P=0.013), and a lower ratio of DV TTP/FA TTP (1.48 ± 0.32 versus 1.94 ± 0.61; P=0.045). Presence of venous varix was significantly associated with hemosiderin (P=0.003). No other clinical or angioarchitectural factors were associated with hemosiderin. Conclusion Shorter MTT through the AVM nidus, lower DV TTP/FA TTP, and the high prevalence of venous varices suggests that high flow is an important feature of unruptured bAVMs with hemosiderin.

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Changes in AVM angio-architecture and hemodynamics after stereotactic radiosurgery assessed by dynamic MRA and phase contrast flow assessments

Abstract: The AVM angioarchitecture has significant impact on the blood flow in feeding arteries. A significant reduction of the shunt volume by successful radiotherapy leads to normalization of the hemodynamics.

Cited by 19 publications

References 32 publications

Results of volume-staged fractionated Gamma Knife radiosurgery for large complex arteriovenous malformations: obliteration rates and clinical outcomes of an evolving treatment paradigm

Results of volume-staged fractionated Gamma Knife radiosurgery for large complex arteriovenous malformations: obliteration rates and clinical outcomes of an evolving treatment paradigm

Stereotactic LINAC radiosurgery for the treatment of brainstem cavernomas

Higher Flow Is Present in Unruptured Arteriovenous Malformations With Silent Intralesional Microhemorrhages

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