Keywords

  • Demographics: Female; 41 years

  • Initial Presentation: Headache for 11 months before radiosurgery treatment

  • Diagnosis: Cerebellar AVM

  • Pre-radiosurgery Treatment: Endovascular embolization twice; at 10 and 3 months before radiosurgery treatment

  • Pre-radiosurgery Presentation: Vertigo, left-sided deafness, and left-sided tinnitus (all are sequelae of previous embolization)

  • Radiosurgery Treatment:

    Adjunctive; linac-based SRS for post-embolization residual, left, cerebellar hemisphere AVM

  • Radiosurgery Dosimetry:

    • Target volume: 3.4 cc

    • Marginal dose: 19.0 Gy

    • Marginal isodose: 75%

    • Maximum dose: 26.8 Gy

    • Minimum dose: 12.3 Gy

    • Average dose: 24.6 Gy

    • Number of isocenters: 1

    • Maximum dose to brain stem: 21.8 Gy

  • Follow-Up Period: 32 months post-SRS

  • Clinical Outcome:

    • 6 months post-SRS:

      • Minimal improvement of vertigo and left-sided tinnitus

      • Stationary left-sided deafness

    • 12 months post-SRS:

      • More improvement of vertigo and left-sided tinnitus

      • Stationary left-sided deafness

    • 18 months post-SRS:

      • Improved vertigo

      • Stationary residual left sided tinnitus

      • Stationary left-sided deafness

    • 32 months post-SRS:

      • Sustainable improvement of vertigo

      • Stationary residual left-sided tinnitus

      • Stationary left-sided deafness

  • Complications: None

  • Radiological Outcome:

    • 6 months post-SRS (MRI): Stationary size of AVM nidus

    • 12 months post-SRS (CTA): Residual small AVM nidus

    • 18 months post-SRS (MRI):

      • Decrease in size of AVM nidus

      • Appearance of perinidal high signal in T2 and FLAIR studies, denoting vasogenic edema

    • 19 months post-SRS (MRA): Residual small AVM nidus

    • 24 months post-SRS (CTA): Residual smaller AVM nidus

    • 32 months post-SRS (conventional angiography): Complete obliteration of AVM nidus

  • Post-radiosurgery Treatment: None

Six cerebellar C T scans for a patient with cerebellar arteriovenous malformation.
Three C T scans and three angiographs of the cerebellum.
Four angiographs represent the cerebellum, 3 months after embolization, and before Stereotactic radiosurgery.
Four C T scans of the cerebellum, 3 months after embolization, and before Stereotactic radiosurgery.
A C T scan illustrates a region of embolization in the left cerebellar hemisphere, two treatment plan layouts, and 2 volumes versus dose graphs of S R P 1 A V M V O I 2 and S R P in progress.
Four cerebellar C T scans of 6 months F U cerebellar arteriovenous malformation.
Three C T scans of the 12-month F U cerebellar arteriovenous malformation.
A set of 4 18 months of F U C T scans of the brain confirmed a region of basal ganglia arteriovenous malformation in the left cerebellar hemisphere.
Two 19-month F U angiographs confirm the occurrence of arteriovenous malformation in the left cerebellar region.
Four C T scans of the 24-month F U depict a cerebellar arteriovenous malformation region.
Six angiographs of the cerebellar region depict some arteriovenous malformation, predominantly in the left hemisphere.
Multiple angiographs, four of which are before S R S angiographs and four are 32 months after S R S angiographs.
Six angiographs, of which 2 represents the condition before embolization, 2 represents the state after embolization, and before S R S, and 2 represents the condition 32 months after S R S.