RT Journal Article
SR Electronic
T1 Radiosurgery of Cerebral Arteriovenous Malformations: Is an Early Angiogram Needed?
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 475
OP 481
VO 20
IS 3
A1 Oppenheim, Catherine
A1 Meder, Jean François
A1 Trystram, Denis
A1 Nataf, François
A1 Godon-Hardy, Sylvie
A1 Blustajn, Jerry
A1 Mérienne, Louis
A1 Schlienger, Michel
A1 Frédy, Daniel
YR 1999
UL http://www.ajnr.org/content/20/3/475.abstract
AB 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.