Keywords

  • Demographics: Male; 22 years

  • Initial Presentation: Epilepsy for 1 year before radiosurgery treatment

  • Diagnosis: Medium size brain AVM

  • Pre-radiosurgery Treatment: None

  • Pre-radiosurgery Presentation:

    • Epilepsy (partial seizures with secondary generalization)

    • Dysphasia

    • Headache

  • Radiosurgery Treatment:

    Upfront (primary); Gamma Knife-based SRS for left, temporal, medium size AVM

  • Radiosurgery Dosimetry:

    • Target volume: 7.0 cc

    • Prescribed dose: 20.0 Gy

    • Isodose line: 50%

  • Follow-Up Period: 24 months post-SRS

  • Clinical Outcome:

    • 6 months post-SRS:

      • Improving seizures with medications

      • Stationary dysphasia

      • Stationary headache

    • 12 months post-SRS:

      • Increased frequency of seizures despite medications

      • Worsened dysphasia

      • Worsened headache

    • 18 months post-SRS:

      • Controlled seizures with medications

      • Improving dysphasia

      • Improving headache

    • 24 months post-SRS:

      • Sustainable control of seizures with medications

      • Mild residual dysphasia

      • Improved headache

  • Complications: None

  • Radiological Outcome:

    • 12 months post-SRS (MRI):

      • Marked decrease in size of AVM nidus

      • Appearance of focal ring enhancing lesion at the site of AVM nidus, in T1 Gadolinium-enhanced study, denoting radiation necrosis

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

    • 18 months post-SRS (MRI):

      • Non-visualized AVM nidus

      • Appearance of small focal encephalomalacia at the site of prior AVM nidus

      • Persistence of high signal in T2 and FLAIR studies at the site of prior AVM nidus

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

  • Post-radiosurgery Treatment: Continued anticonvulsant medications

The three M R I scanned photographs represents the human brain before S R S, and the defective area in the brain is highlighted, measured, and marked by an arrow.
The three photographs represent the computed tomographic angiography scans of the human brain before S R S, and the defective area of the brain is measured and highlighted.
The three microscopic photographs represent the computed tomographic angiography scans of the human brain labeled treatment plan, 20 G y at 50 percent isodose line, 70 cubic capacities, and the defective area of the brain is highlighted.
The three M R I scanned photographs represents the human brain at 12 months follow-up, and the defective area of the brain is highlighted and marked by an arrow.
The two M R I scanned photographs represents the human brain at 18 months follow-up, and the defective area of the brain is highlighted and marked by an arrow.
The three microscopic photographs represent the computed tomographic angiography scans of the human brain at 24 months follow-up.
The six microscopic images represent the computed tomographic angiography scans of the human brain before S R S, and at 24 months follow up.