Shortened Cerebral Circulation Time Predicts Resistance to Obliteration in High-Flow Brain Arteriovenous Malformations After Stereotactic Radiosurgery.

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  • Additional Information
    • Source:
      Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE
    • Publication Information:
      Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.
      Original Publication: Baltimore, Williams & Wilkins.
    • Subject Terms:
      Radiosurgery*/methods ; Intracranial Arteriovenous Malformations*/surgery ; Intracranial Arteriovenous Malformations*/diagnostic imaging ; Intracranial Arteriovenous Malformations*/radiotherapy ; Cerebrovascular Circulation*/physiology ; Angiography, Digital Subtraction*; Humans ; Female ; Male ; Adult ; Middle Aged ; Retrospective Studies ; Young Adult ; Treatment Outcome ; Adolescent ; Cerebral Angiography ; Aged
    • Abstract:
      Background and Objectives: Treatment selection for brain arteriovenous malformations (BAVMs) is complicated by BAVM size, location, and hemodynamics. Quantitative digital subtraction angiography is used to quantify the hemodynamic impact of BAVMs on cerebral circulation. This study investigated the association between cerebral circulation time and the complete obliteration (CO) rate of BAVMs after stereotactic radiosurgery (SRS).
      Methods: We analyzed the data of 143 patients who underwent SRS for BAVMs between January 2011 and December 2019 in our institute. Their pre-SRS magnetic resonance imaging and angiography images were analyzed to acquire BAVM characteristics and quantitative digital subtraction angiography parameters. Modified cerebral circulation time (mCCT) was defined as the time difference between the bolus arrival time of the ipsilateral cavernous internal carotid artery and that of the parietal vein, as determined from the lateral view of images obtained using digital subtraction angiography. Cox regression with hazard ratios and Kaplan-Meier analyses were conducted to determine the associations between the parameters and BAVM CO after SRS.
      Results: Of the 143 patients, 101 (70.6%) achieved BAVM CO. According to the multivariate analyses, an increased mCCT (hazard ratio: 1.24, P = .041) was the independent factor associated with BAVM CO after adjustment for age, sex, hemorrhagic presentation, a BAVM volume of >5 cm 3 , and a margin dose of >18 Gy. Individuals with an mCCT of ≤2.32 s had a lower 36-month probability of BAVM CO than did those with an mCCT of >2.32 s (44.1% ± 6.8% vs 63.3% ± 5.6%, P = .034).
      Conclusion: The hemodynamic impact of high-flow BAVM demonstrated by a shortened mCCT is associated with a lower BAVM CO rate after SRS.
      (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
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    • Grant Information:
      V113C-035 Taipei Veterans General Hospital; MOST-112-2314-B-A49-064- Ministry of Science and Technology, Taiwan
    • Publication Date:
      Date Created: 20240620 Date Completed: 20241205 Latest Revision: 20241205
    • Publication Date:
      20241209
    • Accession Number:
      10.1227/neu.0000000000003036
    • Accession Number:
      38899888