• Neurosurgery · Oct 2012

    Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation.

    • Kwame Amponsah, Thomas L Ellis, Michael D Chan, James F Lovato, J Daniel Bourland, Allan F deGuzman, Kenneth E Ekstrand, Michael T Munley, Kevin P McMullen, Edward G Shaw, and Stephen B Tatter.
    • Departments of *Neurosurgery and ‡Radiation Oncology §Division of Public Health Sciences, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
    • Neurosurgery. 2012 Oct 1;71(4):893-9.

    BackgroundIt has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs).ObjectiveTo evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration.MethodsForty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years. One group was planned with integrated stereotactic angiography and MR (spoiled gradient recalled) images obtained on the day of GKS. A second technique avoided the risk of arteriography by using only axial MR images. Beginning in 2007, PASL MR perfusion imaging was routinely performed as a portion of the follow-up MRI to assess the restoration of normal blood flow of the nidus and surrounding area.ResultsThe overall obliteration rate for the angiography/MRI group was 88.0% (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5% (8 of 13), with P=.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P=.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging.ConclusionThis retrospective analysis shows that treatment planning technique used in GKS does not play a role in the eventual obliteration of treated AVMs. PASL may have potential in the evaluation of AVM obliteration.

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