Cerebral arteriovenous malformations: the value of radiologic parameters in predicting response to radiosurgery.

PURPOSE To define the morphological patterns of cerebral arteriovenous malformations (AVMs) that influence their response to radiosurgery at 2 years. METHODS We retrospectively reviewed the yearly MR and angiographic follow-up studies in 102 patients who had radiosurgical treatment for cerebral AVMs between 1990 and 1992. Parameters studied were maximum length and volume of the nidus, position relative to the midline, anatomic structures involved, sectional anatomic location (depth within the brain tissue), angioarchitecture, and Spetzler and Martin grading. Statistical analysis determined their influence on treatment results at 2 years. RESULTS Parameters that correlated with obliteration at 2 years were maximum length less than 25 mm, small volume, sectional location deep within brain tissue, and plexiform angioarchitecture. Ventricular and paraventricular locations correlated with nonobliteration at 2 years. CONCLUSION This study highlights the role of two new morphological parameters in predicting the efficiency of radiosurgery in the treatment of cerebral AVMs: depth within the parenchyma and angioarchitecture. It also emphasizes the usefulness of sectional imaging in the work-up before radiosurgery.

[1]  [Radiosurgical treatment of minor intracranial arteriovenous malformations by using a linear accelerator]. , 1992, Neuro-Chirurgie.

[2]  E. Lo.  Linear Accelerator Radiosurgery of Cerebral Arteriovenous Malformations , 1994 .

[3]  G. Pike,et al.  Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. , 1990, International journal of radiation oncology, biology, physics.

[4]  R D Adams,et al.  Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. , 1983, The New England journal of medicine.

[5]  C. Lindquist,et al.  Combined Embolization and Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformations , 1993, Acta radiologica.

[6]  H. Duvernoy,et al.  AVM of the brain, history, embryology, pathological considerations, hemodynamics, diagnostic studies, microsurgical anatomy , 1987 .

[7]  D Lefkopoulos,et al.  A 3-D radiosurgical methodology for complex arteriovenous malformations. , 1993, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[8]  D. Kondziolka,et al.  Repeat stereotactic radiosurgery of arteriovenous malformations: factors associated with incomplete obliteration. , 1996, Neurosurgery.

[9]  B. Guidetti,et al.  Intracranial arteriovenous malformations. Conservative and surgical treatment. , 1980, Journal of neurosurgery.

[10]  C Mistretta,et al.  Treatment of arteriovenous malformations with stereotactic radiosurgery employing both magnetic resonance angiography and standard angiography as a database. , 1993, International journal of radiation oncology, biology, physics.

[11]  F J Bova,et al.  Linear accelerator radiosurgery for arteriovenous malformations. , 1992, Journal of neurosurgery.

[12]  O Betti,et al.  [Multiple-beam stereotaxic irradiation]. , 1983, Neuro-Chirurgie.

[13]  C. Lindquist,et al.  Long-term results of radiosurgery for arteriovenous malformation: neurodiagnostic imaging and histological studies of angiographically confirmed nidus obliteration. , 1992, Surgical neurology.

[14]  J. Adler,et al.  Clinical outcome of radiosurgery for cerebral arteriovenous malformations. , 1992, Journal of neurosurgery.

[15]  E. Shaw,et al.  Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate. , 1995, Journal of neurosurgery.

[16]  C. Ogilvy.  Radiation Therapy for Arteriovenous Malformations: A Review , 1990, Neurosurgery.

[17]  J. T. Murphy,et al.  Treatment of arteriovenous malformations with the linear accelerator. , 1987 .

[18]  K. Davis,et al.  Bragg peak proton beam therapy for arteriovenous malformation of the brain. , 1983, Clinical neurosurgery.

[19]  F J Bova,et al.  Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. , 1995, Journal of neurosurgery.

[20]  J. Tew,et al.  Management strategies and surgical techniques for deep-seated supratentorial arteriovenous malformations. , 1995, Neurosurgery.

[21]  D. Forster,et al.  Results of stereotactic radiosurgery of arteriovenous malformations: an analysis of 52 cases. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[22]  C Munari,et al.  Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. , 1989, Neurosurgery.

[23]  C. Mottolese,et al.  Multidisciplinary treatment of cerebral arteriovenous malformations. , 1995, Neurological research.

[24]  D. Kondziolka,et al.  Radiosurgery for vascular malformations of the brain stem. , 1993, Acta neurochirurgica. Supplementum.

[25]  K. Stelzer,et al.  Stereotactic radiosurgery: a review and comparison of methods. , 1994, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  M. Phillips,et al.  Stereotactic heavy-charged-particle Bragg-peak radiation for intracranial arteriovenous malformations. , 1990, The New England journal of medicine.

[27]  J. Debus,et al.  The role of high-dose, single-fraction irradiation in small and large intracranial arteriovenous malformations. , 1994, International journal of radiation oncology, biology, physics.

[28]  C. Mottolese,et al.  Prognostic value of the Spetzler's grading system in a series of cerebral AVMs treated by a combined management , 2005, Acta Neurochirurgica.

[29]  C. Lindquist,et al.  Stereotactic Radiosurgical Treatment of Arteriovenous Malformations , 1988 .

[30]  R F Spetzler,et al.  A proposed grading system for arteriovenous malformations. , 1986, Journal of neurosurgery.

[31]  C. Lindquist,et al.  Postradiation volume changes in gamma unit-treated cerebral arteriovenous malformations. , 1993, Surgical neurology.

[32]  G Luxton,et al.  Stereotactic radiosurgery: principles and comparison of treatment methods. , 1993, Neurosurgery.

[33]  Linear accelerator radiosurgery of cerebral arteriovenous malformations: an update. , 1994, Neurosurgery.

[34]  L. Lunsford,et al.  Treatment of arteriovenous malformations of the brain with combined embolization and stereotactic radiosurgery: results after 1 and 2 years. , 1990, AJNR. American journal of neuroradiology.

[35]  L D Lunsford,et al.  Stereotactic radiosurgery for arteriovenous malformations of the brain. , 1991, Journal of neurosurgery.