• Yong-Sin Hu, Cheng-Chia Lee, Hsiu-Mei Wu, Huai-Che Yang, Te-Ming Lin, Chao-Bao Luo, Wan-Yuo Guo, Wen-Yuh Chung, and Chung-Jung Lin.
• Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
• Neurosurgery. 2020 Aug 1; 87 (2): 338-347.

BackgroundGamma Knife radiosurgery (GKRS) obliterates 65% to 82% of brain arteriovenous malformations (BAVMs).ObjectiveTo explore the impact of hemodynamics on GKRS outcomes.MethodsWe retrospectively (2011-2017) included 98 patients with BAVMs who had received GKRS alone. Two evaluators, blinded to the outcomes, analyzed the pre-GKRS angiography and magnetic resonance images to obtain the morphological characteristics and quantitative digital subtraction angiography (QDSA) parameters. The venous stasis index was defined as the inflow gradient divided by the absolute value of the outflow gradient. Patients' follow-up magnetic resonance or digital subtraction angiography images were evaluated for the presence of complete obliteration (CO). Cox regression and Kaplan-Meier analyses were conducted to determine the correlations between the parameters and outcomes.ResultsAmong the 98 patients, 63 (63.4%) achieved CO after GKRS at a median latency period of 31 mo. In multivariable analyses with adjustments for age and sex, increased BAVM volume (hazard ratio (HR) 0.949, P = .022) was an independent characteristic predictor, and venous stenosis (HR 2.595, P = .009), venous rerouting (HR 0.375, P = .022), and larger stasis index (HR 1.227, P = .025) were independent angiographic predictors of CO. BAVMs with a stasis index of >1.71 had a higher 36-mo probability of CO than those with a stasis index of ≤1.71 (61.1% vs 26.7%, P < .001).ConclusionBAVMs with a larger stasis index, indicating more stagnant venous outflow, may predict obliteration after GKRS. QDSA analysis may help in predicting BAVM treatment outcomes and making therapeutic decisions.Copyright © 2019 by the Congress of Neurological Surgeons.

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