Monitoring volume changes following stereotactic radiosurgical treatment in the nidus of an intracranial arteriovenous malformation with the use of MR angiography based 3D volumetric study

Authors: I. Vachaľová 1;  A. Ďurkovský 2;  M. Šramka 3;  P. Traubner 1
Authors‘ workplace: 1. neurologická klinika LF UK a FNsPB, Bratislava 1;  Klinika stereotaktickej rádiochirurgie OÚSA, Bratislava 2;  Klinika rádiodiagnostiky TU a OÚSA, Bratislava 3
Published in: Cesk Slov Neurol N 2007; 70/103(5): 527-532
Category: Original Paper

Poďakovanie: Naša úprimná vďaka patrí kolektívu neurochirurgov, rádioterapeutov, rádioonkológov, radiačných fyzikov a rádiodiagnostikov Onkologického Ústavu svätej Alžbety v Bratislave, ktorí sa svojou dennou obetavou prácou zaslúžili o dosiahnuté výsledky rádiochirugickej liečby pacientov s intrakraniálnymi arteriovenóznymi malformáciami.
Za finančnú podporu vďačíme grantu poskytnutému firmou Wyeth a Grantu Univerzity Komenského.
Všetky MR vyšetrenia sa uskutočnili na 1T supravodivom systéme Harmony firmy Siemens.


Intracranial arteriovenous malformation (AVM) is a vascular anomaly jeopardising the affected person due to the risk of intracranial haemorrhage. Stereotactic radiosurgery is a mini-invasive method of treatment of AVM with the possibility of unlimited access to all the locations in the brain. The effect of treatment can be expected after 1 to 3 years.

Define the volumetric change of an irradiated AVM nidus in the period of one year post-surgery using the method of 3D volumetric study based on magnetic resonance angiography (MRA). Observe the method of volumetric change monitoring with traditional angiography (DSA) on the basis of available literary data. Determine adequate percentage of volumetric change of AVM nidus and find out whether the speed of obliteration depends on the initial size of the nidus and on the therapeutic dose of irradiation.

Set and methods:
Irradiation dose of 12 to 20 Gy (17.52 Gy on an average) was applied to a set of 31 patients aged 35 years, in the volume of 0.3–21.3 cm3 (6.21 cm3 on an average). 3D volumetric MRA based study was used for the calculation of volumetric changes. The non-parametric correlation method was used for testing the defined parameters.

Using the 3D volumetric study, we discovered an average 64 % reduction of AVM nidus volume as early as one year after radiosurgery. The percentage of reduction depends on the therapeutic dose of irradiation (p = 0.031).

MRA based 3D volumetric study allows for a very precise assessment of the dynamism of even the smallest volumetric changes following radiosurgical irradiation. The 3D volumetric study appears as a suitable method for the follow up of effects of radiosurgical therapy of AVM. MRA is a non-invasive method allowing for detailed imaging of arteries in a 3D image with high spatial resolution. The information obtained is significant from the prognosis point of view, and for further management of the patients.

Key words:
arteriovenous malformation – 3D volumetric study – MR angiography – stereotactic radiosurgery


Doppman JL. The nidus concept of spinal cord arteriovenous malformations. A surgical recommendations based upon angiographic observations. Br J Radiol 1971; 44: 758-763.

2. Kloster R. Subarachnoid hemorrhage in Vestfold country. Occurence and prognosis. Tidsskr Nor Laegeforen 1997; 117: 1879-1882.

3. Brown RD, Wiebers DO, Forbes G, O´Fallon WM, Piepgras DG, Marsh WR et al. The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 1988; 68: 352-357.

4. Wilkins RH. Natural history of intracranial vascular malfomations: a review. Neurosurgery 1985; 16(3): 421-430.

5. Graf CJ, Perret GE, Torner JC. Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 1983; 58: 331-337.

6. Fults D, Kelly DL. Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 1984; 15: 658-662.

7. Forster DM, Steiner L, Hakanson S. Arteriovenous malformations of the brain: a long term clinical study. J Neurosurg 1972; 37: 562-570.

8. Crawford PM, West CR, Chadwick DW, Shaw MD. Arteriovenous malformations of the brain: the natural history in unoperated patients. J Neurol Neurosurg Psychiatry 1986; 49: 1-10.

9. Ondra SL, Troupp H, George ED, Schwab K. The natural history of symptomatic arteriovenous malformations of the brain: a 24 year follow up assessment. J Neurosurg 1990; 73: 387-391.

10. Schneider BF, Eberhard DA, Steiner LE. Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 1997; 187: 352-357.

11. Spiegelmann R, Friedman WA, Bova FJ. Limitations of angiografic target localization in planning radiosurgical treatment. Neurosurgery 1992; 30: 619-624.

12. Ďurkovský A. MR angiografia pri stereotaktickej rádiochirurgii AV malformácií mozgu a pre kontrolu jej liečebných účinkov (Dizertačná práca). Bratislava: Trnavská univerzita 2005.

13. Oppenheim C, Meder JF, Trystram D, Nataf F, Godn-Hardy S, Blustajn J et al. Radiosurgery of cerebral arteriovenous malformations: Is an early angiogram needed? American Journal of Neuroradiology 1999; 20: 475-481.

14. Gauvrit JY, Oppenheim C, Nataf F, Naggara O, Trystram D, Munier T et al. Three-dimensional dynamic magnetic resonance angiography for the evaluation of radiosurgically treated cerebral arteriovenous malformations. Eur Radiol 2005a; 10: 1007- 1011.

15. Souhami L, Olivier A, Podgorsak EB, Pla M, Pike GB. Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 1990; 19: 775-782.

16. Colombo F, Benedetti A, Pozza F, Marchetti Ch, Chierego G. Linear Accelerator Radiosurgery of Cerebral Arteriovenous Malformations. Neurosurgery 1989; 24: 833-840.

17. Betti OO, Munari C, Rosler R. Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 1989; 24: 311-321.

18. Pica A, Ayzac L, Sentenac I, Rocher FP, Pelissou-Guyotat I, Emery JC et al. Stereotactic radiosurgery for arteriovenous malformations of the brain using a standard linear accelerator: the Lyon experience. Radiotherapy and Oncology 1996; 40: 51-54.

19. Friedman WA, Bova FJ. Linear accelerator radiosurgery for arteriovenous malformations. J Neurosurg 1992; 77: 832-841.

20. Friedman WA, Bova FJ, Mendenhall WM. Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. J Neurosurg 1995; 82: 180-189.

21. Zabel A, Milker-Zabel S, Huber P, Schiltz-Ertner D, Schlegel W, Debus J. Treatment outcome after linac-based radiosurgery in cerebral arteriovenous malformations: Retrospective analysis of factors affecting obliteration. Radiotherapy and Oncology 2005; 77(1): 105-10.

22. Sirin S, Kondziolka D, Niranjan A, Flickinger JC, Maitz AH, Lundsford LD. Prospective staged volume radiosurgery for large arteriovenous malformations: indications and outcomes in otherwise untreatable patients. Neurosurgery 2006; 58(1): 17-27.

23. Ellis TL, Friedman WA, Bova FJ, Kubilis PS, Buatti JM. Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurgery 1998; 89: 104-110.

24. Pollock BE, Flickinger JC, Lundsford LD, Maitz A, Kondziolka D. Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 1998; 42(6): 1239-1244.

25. Zipfel GJ, Bradshaw P, Bova FJ, Friedman WA. Do the morfological characteristics of arteriovenous malformations affect the results of radiosurgery? J Neurosurgery 2004; 101(3): 393-401.

26. Massoud TF, Hademenos GJ, De Salles AF, Solberg TD. Experimental Radiosurgery Simulations Using a Theoretical Model of Cerebral Arteriovenous Malformations. Stroke 2000; 31(10): 2466.

27. Steiner L, Lindquist Ch, Adler JR, Torner JC, Alves W, Steiner M. Clinical outcome of radiosurgery for cerebral arteriovenous malformations. J Neurosurg 1992; 77: 1-8.

28. Brada M, Kitchen N. How effective is radiosurgery for arteriovenous malformations? J Neurol Neurosurg Psychiatry 2000; 68: 548-549.

Paediatric neurology Neurosurgery Neurology

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