Late morphological changes after radiosurgery of brain arteriovenous malformations: an MRI study.
BACKGROUND
Radiosurgery by Gamma Knife (GK) is an effective treatment for brain arteriovenous malformations (AVM). The aim of the present study was to evaluate late, radiation-induced changes detectable by MRI after AVM radiosurgery in patients treated minimally 10 years prior, with AVM obliteration proven by angiography.


METHODS
Thirty-five patients with 37 AVMs were included. AVMs were irradiated 16.6 ± 3.5 years prior with AVM obliteration proven 13 ± 4 years prior. All patients underwent recent MRI examinations, including application of gadolinium-based contrast.


RESULTS
In one case, post-irradiative cystic formation with mass effect and signs of hemorrhage requiring surgery was found. Post-gadolinium enhancement at the site of obliterated nidi was apparent in 28 of 37 cases (76 %). In all cases except one, the mean volume of enhancement at the time of review was clearly lower than the volume of the originally irradiated AVM (88 ± 20 %; median 92 %); in one case the extent was 142 % greater than the irradiated AVM. When we compared enhancing and non-enhancing nidi, we found that enhancing nidi were significantly larger than non-enhancing nidi at the time of radiosurgery (4.39 ± 3.35 cc vs. 0.89 ± 0.79 cc, p = 0.004). Enhancement was not influenced by total radiation dose, patient age at the time of irradiation, duration since radiosurgery, or the number of irradiations. Wallerian degeneration was found in nine of 37 cases (24 %); in six cases the optical tracts were affected and visual field defects were proven. In five of nine cases (55.6 %) with Wallerian degeneration previous hemorrhage was present. Dual vascular pathology was found in eight of 35 patients (23 %).


CONCLUSIONS
GK radiosurgery for AVM is a safe treatment method although delayed complications may occur. Post-gadolinium enhancement of obliterated nidi may indicate an active post-irradiative process.
['Malikova|Hana|H|', 'Koubska|Eva|E|', 'Vojtech|Zdenek|Z|', 'Weichet|Jiri|J|', 'Syrucek|Martin|M|', 'Sroubek|Jan|J|', 'Rulseh|Aaron|A|', 'Liscak|Roman|R|']
D000293:Adolescent D000328:Adult D000368:Aged D016063:Blood Loss, Surgical D001921:Brain D002533:Cerebral Angiography D005260:Female D006801:Humans D002538:Intracranial Arteriovenous Malformations D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D011183:Postoperative Complications D016634:Radiosurgery
Post-irradiation Wallerian degeneration Cyst formation Gadolinium enhancement