Abstract
A 21-year-old female, who had two previous attacks of intraventricular hemorrhage, presented with chronic headache. She was treated with upfront (primary); Linac-based SRS for right, lateral ventricle (body) AVM. The target volume of 3.6 cc received a marginal dose of 22.0 Gy normalized to 80% isodose line. At 24 months post-SRS, the patient reported complete resolution of his headaches. Serial post-SRS follow-up MRIs showed progressive reduction in size of AVM nidus, coupled with perinidal high signal in T2 and FLAIR studies, denoting vasogenic edema, and periventricular perinidal focal enhancement in T1 Gadolinium-enhanced study. At 112 months post-SRS, MRI showed non-visualized AVM nidus. At last follow-up (120 months post-SRS), computerized tomography angiography (CTA) documented complete obliteration of AVM nidus. The radiosurgery treatment was successful and without side effects.
Access provided by Autonomous University of Puebla. Download chapter PDF
Similar content being viewed by others
Keywords
- Arteriovenous malformation
- Intraventricular AVM
- Choroid plexus AVM
- Stereotactic radiosurgery
- Linear accelerator
- Linac-based radiosurgery
- Primary SRS
- Computerized tomography angiography
- Perinidal edema
- Nidus obliteration
- Encephalomalacia
-
Demographics: Female; 21 years
-
Initial Presentation: Hemorrhage (intraventricular), which occurred twice; at 10 years and 2 months before radiosurgery treatment
-
Diagnosis: Intraventricular AVM
-
Pre-radiosurgery Treatment: None
-
Pre-radiosurgery Presentation: Chronic headache
-
Radiosurgery Treatment:
Upfront (primary); Linac-based SRS for right, lateral ventricle (body) AVM
-
Radiosurgery Dosimetry:
-
Target volume: 3.6 cc
-
Marginal dose: 22.0 Gy
-
Marginal isodose: 80%
-
Maximum dose: 27.6 Gy
-
Minimum dose: 18.7 Gy
-
Average dose: 26.5 Gy
-
Number of isocenters: 1
-
-
Follow-Up Period: 120 months post-SRS
-
Clinical Outcome:
-
6 months post-SRS: Still having recurrent attacks of annoying headache
-
12 months post-SRS: Improving headache with medications
-
24 months post-SRS: Improved headache
-
-
Complications: None
-
Radiological Outcome:
-
6 months post-SRS (MRI): Decrease in size of AVM nidus
-
12 months post-SRS (MRI): Stationary decrease in size of AVM nidus
-
24 months post-SRS (MRI):
-
More decrease in size of AVM nidus
-
Appearance of right periventricular perinidal high signal in T2 and FLAIR studies, denoting vasogenic edema
-
Appearance of right periventricular perinidal focal enhancement in T1 Gadolinium-enhanced study
-
-
30 months post-SRS (MRI):
-
More decrease in size of AVM nidus
-
Moderate decrease of right periventricular perinidal high signal in T2 and FLAIR studies
-
Moderate decrease of right periventricular perinidal focal enhancement in T1 Gadolinium-enhanced study
-
-
112 months post-SRS (MRI):
-
Non-visualized AVM nidus
-
Resolution of right periventricular perinidal high signal in T2 and FLAIR studies
-
Resolution of right periventricular perinidal focal enhancement in T1 Gadolinium-enhanced study
-
Appearance of right periventricular perinidal focal encephalomalacia
-
-
113 months post-SRS (CT):
-
Presence of tiny right periventricular subependymal calcification expressing minimal mass effect with dilatation of ipsilateral right lateral ventricle
-
-
120 months post-SRS (CTA): Complete obliteration of AVM nidus
-
-
Post-radiosurgery Treatment: None
Further Reading
Abdelaziz OS, Abdelaziz A, Rostom Y, et al. LINAC radiosurgery of intracranial arteriovenous malformations: a single-center initial experience. Neurosurg Q. 2011;21:85–96.
Brada M, Kitchen N. How effective is radiosurgery for arteriovenous malformations? J Neurol Neurosurg Psychiatry. 2000;68:548–9.
Daou BJ, Palmateer G, Wilkinson DA, et al. Radiation-induced imaging changes and cerebral edema following stereotactic radiosurgery for brain AVMs. Am J Neuroradiol. 2021;42:82. https://doi.org/10.3174/ajnr.A6880.
Mobin F, De Salles AAF, Abdelaziz O, et al. Stereotactic radiosurgery of cerebral arteriovenous malformations: appearance of perinidal T2 hyperintensity signal as a predictor of favorable treatment response. Stereotact Funct Neurosurg. 1999;73(1–4):50–9.
Santoreneos S, Blumbergs PC, Jones NR. Choroid plexus arteriovenous malformations. A report of four pathologically proven cases and review of the literature. Br J Neurosurg. 1996;10(4):385–90.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Abdelaziz, O.S., De Salles, A.A.F. (2023). Intraventricular Arteriovenous Malformation (AVM). In: NeuroRadiosurgery: Case Review Atlas. Springer, Cham. https://doi.org/10.1007/978-3-031-16199-5_5
Download citation
DOI: https://doi.org/10.1007/978-3-031-16199-5_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-16198-8
Online ISBN: 978-3-031-16199-5
eBook Packages: MedicineMedicine (R0)