Neurovascular Radiosurgery

Abstract

<jats:p> This article focuses on the treatment of neurovascular diseases, in particular brain arteriovenous malformations (BAVMs), with radiosurgery. The target group for this review is physicians who manage patients with neurovascular diseases, but are not actively engaged in radiosurgery. </jats:p><jats:p> Radiosurgery for BAVMs is an established treatment with clearly defined risks and benefits. The efficacy of radiosurgery for dural arteriovenous shunts (DAVSs) is probably similar but the treatment has not yet gained the same acceptance. Radiosurgical treatment of cavernomas (cavernous hemangiomas) remains controversial. </jats:p><jats:p> Well founded predictive models for BAVM radiosurgery show: </jats:p><jats:p> The probability of obliteration depends on the dose of radiation given to the periphery of the BAVM. The risk of adverse radiation effects depends on the total dose of radiation, i.e. the amount of energy imparted into the tissue. The risk is greater in centrally located lesions. The risk of damage to brainstem nucleii and cranial nerves must be added to the risk predicted from current outcome models. The risk of hemorrhage during the time span before obliteration depends on the BAVM volume, the dose of radiation to the periphery of the lesion and the age of the patient. Central location is a probably also a risk factor. </jats:p>

Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery

“…Conventional MR imaging techniques also have limited sensitivity for small AVM nidi. 25 Despite that the advancements in MR imaging technique such as 4D-MRA have enabled temporal information to be recorded, its limitations are still prominent. 26,27 Additionally, differences in AVM nidus contouring-derived MR images increase the likelihood of mismatch between the dose contour and the exact nidus volume during treatment planning.…”

The Rare Association of Moyamoya Disease and Cerebral Arteriovenous Malformations: a Case Report

“…Gamma-knife radiosurgery (GKRS) is an established treatment alternative for cAVM with clearly defined benefits and risks. The risks include adverse radiation effects and a risk of intracranial hemorrhage that develops during the latency period after GKRS ( 3 ). We present here a case of moyamoya disease that developed after cAVM radiosurgery.…”