Keywords

  • Demographics: Male; 37 years

  • Initial Presentation: Chronic headache

  • Diagnosis: Rolandic AVM

  • Pre-radiosurgery Treatment: None

  • Pre-radiosurgery Presentation: Chronic headache

  • Radiosurgery Treatment:

    Upfront (primary); Linac-based SRS for right, rolandic (motor cortex) AVM

  • Radiosurgery Dosimetry:

    • Target volume: 6.3 cc

    • Marginal dose: 15.0 Gy

    • Marginal isodose: 75%

    • Maximum dose: 20.6 Gy

    • Minimum dose: 13.5 Gy

    • Average dose: 18.9 Gy

    • Number of isocenters: 1

  • Follow-Up Period: 62 months post-SRS

  • Clinical Outcome:

    • 6 months post-SRS: Persistence of annoying attaches of headache

    • 24 months post-SRS: Slightly improving headaches with medications

    • 60 months post-SRS: Persistence of mild attaches of headache

  • Complications: None

  • Radiological Outcome:

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

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

    • 24 months post-SRS (MRI):

      • Stationary size of AVM nidus

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

    • 36 months post-SRS (MRI):

      • Stationary size of AVM nidus

      • Increased perinidal high signal in T2 and FLAIR studies

      • Appearance of perinidal focal encephalomalacia showing heterogeneous enhancement in T1 Gadolinium-enhanced study

    • 60 months post-SRS (MRI):

      • Slight decrease in size of AVM nidus

      • Persistent increased perinidal high signal in T2 and FLAIR studies

      • Persistence of perinidal heterogeneously enhancing focal encephalomalacia in T1 Gadolinium-enhanced study

    • 61 months post-SRS (CT):

      • Persistence of perinidal heterogeneously enhancing focal encephalomalacia in contrast-enhanced study

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

  • Post-radiosurgery Treatment: Watchful waiting for delayed complete obliteration of the residual AVM nidus during an extended follow-up period before deciding repeat radiosurgery treatment

Seven scanned images of a 37 year old male patient represent the view before S R S. An arrow indicates the location and size of A V M nidus.
The four scanned images of the brain of a 37 year old male patient before S R S.
Two scanned images represent the treatment day view of the brain. An arrow points at A V M nidus.
Seven M R I scan images during six months follow up after S R S treatment. An arrow points to the stationary size of the A V M nidus.
Seven M R I images of a 37 year old male patient during 12 months follow up after S R S treatment. Arrows indicate the stationary size of A V M nidus.
Seven M R I scan images of a 37 year old male patient during 24 months follow up after S R S treatment. Arrows indicate the stationary size of A V M nidus.
Seven M R I scan images of the patient during 36 months follow up after S R S treatment. Arrows indicate the stationary size of A V M nidus.
Seven M R I scan images of the patient during 60 months follow up after S R S treatment. Arrows indicate a slight decrease size of A V M nidus.
Four pairs of M R I scan images of the patient before S R S and 60 months follow up after S R S treatment. Arrows indicate a slight decrease in the size of A V M nidus.
A pair of C T scan images of the patient during 61 months follow up after S R S treatment, arrows indicate perinidal heterogeneously enhancing focal encephalomalacia.
Four C T A images of the patient during 62 months follow up after S R S treatment, indicate residual smaller A V M nidus.
A comparison of 3 C T images of the patient before S R S treatment with 3 C T A scan images of the patient during 62 months follow up after S R S treatment. A residual and smaller A V M nidus is noticed in the follow up scan images.