3d-ct Angiography In The Treatment Planning Of Cerebral Avm?s

Natsis Nikos1, Ioannis Ioannidis1, Michael Torrens1, Chryssa Paraskevopoulou1, Alekos Andreou1

1Hygeia Hospital, Athens, Greece

Keywords: angiography, arteriovenous malformation, computed tomography, Imaging, technique

Interactive Manuscript

Ask Questions of this Manuscript:



     We report our experience with CT angiography (CTA) in the treatment planning for radiosurgery of cerebral arteriovenous malformations (AVM).
     Between 2004 and 2009, 115 patients with AVM were treated by Gamma Knife radiosurgery in our institution. 80 patients had prior embolisation therapy with NBCA and/or PVA, aiming to reduce the size and flow and to eliminate vascular structures, such as aneurysms and high flow fistulas, which are associated with an increased risk of haemorrhage. 4 patients that were embolised with Onyx were excluded from the study since the quality of CTA in the presence of Onyx is impaired. 35 patients underwent Gamma Knife treatment alone.  
     In all cases DSA, 3D-CTA and gadolinium enhanced MRI were performed and used in treatment planning and the relative value of these investigations was evaluated.
     Complete obliteration was accomplished in 57 of 64 patients (89%) where there is a complete 2 year follow up protocol with DSA. 3D-CTA, in conjunction with the axial high resolution post contrast CT, was judged to be the most helpful in precisely delineating the nidus. The target volume was found to be downsized in most cases when compared with DSA and MRA. When angiogenesis was present in the close proximity of the nidus, consultation with the DSA images was necessary. Clinical examples will be demonstrated.
     This is a retrospective study.
     3D-CTA is a critical investigation that should be performed in all patients as a part of treatment planning for Gamma Knife Radiosurgery of AVM’s.


Project Roles:

N. Nikos (), I. Ioannidis (), M. Torrens (), C. Paraskevopoulou (), A. Andreou ()