J Korean Radiol Soc.  1998 Nov;39(5):847-855. 10.3348/jkrs.1998.39.5.847.

Radiologic Evaluation of the Therapeutic Effect of Gamma Knife Radiosurgery in Cerebral Vasular Malformation

• Kim ID
• Kim I
• Jeon YS
• Lee JY
• Lee YJ
• Cha SS
• Eun CK
• Kim MS
• Sim JH

• KMID: 2201135
• DOI: http://doi.org/10.3348/jkrs.1998.39.5.847

Abstract

PURPOSE: To evaluate the therapeutic effect of gamma knife radiosurgery in cerebral vascular malformationusing a radiologic imaging method such as MRI or angiography.
MATERIALS AND METHODS
We retrospectively reviewedMRIs, Ct scans and angiograms of 29 cases of arteriovenous malformation and 15 of cavernous malformation beforeand after gamma knife radiosurgery. The patients underwent follow-up radiologic studies for between 6 and 35months after radiosurgery. No patient underwent ofter surgery of embolization. Radiological imaging analysisfocused on changes in the volume of the nidus or central core. Other findings of edema, cystic change, hemorrhage,signal intensity, enhancement and distributional vascular markings were also studied. The volume of the AVM niduswas measured and assigned ot one of four groups : <1cc, 1-4cc,> 4-10cc and> 10cc.
RESULTS
In arteriovenousmalformation cases, the volume of the nidus decreased by mean 60.2%; reduction was greatest(68.1%) in the 1-4ccgroup. Three cases showed complete loss of the nidus at 9, 12 and 25 months after radiosurgery, respectively. Innine cases, dereased caliber or loss of draining vein was noted. High signal intensity on T2-weighted MR images,suggesting either edema or demyelination, was observed in four cases. In cavernous angioma cases, core volume wasreduced by 36.8%. Transient cerebral edema and presumed radiation necrosis were observed in two cases and one,respectively.
CONCLUSION
Gamma knife suregery was effective in nearly all cases of arteriovenous malformationand some cases of cavernous malformation. More than two years follow-up involving radiologic imaging such as MRIis needed for the evaluation of therapeutic effect and diagnosis of complications.

Keyword

Brain, MR; Brain, Angiography; Arteriovenous malformations, cerebral; Angioma, central nervous system

MeSH Terms

Angiography
Arteriovenous Malformations
Brain Edema
Demyelinating Diseases
Diagnosis
Edema
Follow-Up Studies
Hemangioma, Cavernous
Humans
Intracranial Arteriovenous Malformations
Magnetic Resonance Imaging
Necrosis
Radiosurgery*
Retrospective Studies
Tomography, X-Ray Computed
Veins