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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 20:475-481 (3 1999)
© 1999 American Society of Neuroradiology

ARTICLE

Radiosurgery of Cerebral Arteriovenous Malformations: Is an Early Angiogram Needed?

Catherine Oppenheim^a, Jean François Meder^,a, Denis Trystram^a, François Nataf^a, Sylvie Godon-Hardy^a, Jerry Blustajn^a, Louis Mérienne^a, Michel Schlienger^a and Daniel Frédy^a

^a From the Departments of Neuroradiology (C.O., J.F.M., D.T., S.G.-H., J.B.) and Neurosurgery (F.N., L.M.), Centre Hospitalier Sainte-Anne, Paris; the Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, and the Department of Radiotherapy (M.S.), Hôpital Tenon, Paris.

BACKGROUND AND PURPOSE: Radiosurgical treatment of arteriovenous malformations (AVMs) has slow and progressive vasoocclusive effects. We sought to determine if early posttherapeutic angiography provides relevant information for the management of radiosurgically treated AVMs.

METHODS: Between 1990 and 1993, the progress of 138 of 197 cerebral AVMs treated by linear accelerator (Linac) was regularly followed by angiographic study. On each posttherapeutic angiogram ("early," 6–18-month follow-up; "intermediate," 19–29-month-follow-up; and "late," >30-month follow-up), the degree of reduction across the greatest diameter of the nidus and hemodynamic modifications were analyzed. Each cerebral AVM was qualitatively classified into one of the following categories after early angiographic study: 0%-reduced, 25%-reduced, 50%-reduced, 75%-reduced, and 100%-reduced or "complete obliteration." Vasoocclusive progress for each category was then studied over time.

RESULTS: Three (10%) of the 30 0–25%-reduced, eight (38%) of 21 50%-reduced, and 27 (84%) of 32 75%-reduced cerebral AVMs showed complete obliteration after further follow-up. The three 0–25%-reduced AVMS that went on to complete obliteration underwent very early angiography (6–7 months). Fifty-five cerebral AVMs showed complete obliteration on early angiograms (40%). In this group, more follow-up, when performed, confirmed complete obliteration in all cases (n = 17).

CONCLUSION: An early angiogram is needed to predict the effectiveness of radiosurgery. Important AVM changes seen on early angiograms are highly correlated with treatment success. Moreover, no or minor changes seen on early angiograms are highly predictive of radiosurgical failure. For these patients, further treatment should be discussed promptly.

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