Keywords

  • 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

Four M R I scan images of a brain labeled before S R S. An arrow in each scan points to a tumor on the brain.
Six M R I scan images of a brain labeled before S R S. An arrow in each scan points to a tumor on the brain.
Four scanned images appear as smoky-like structures labeled before S R S.
Two M R I reports of a brain of a patient diagnosed with intraventricular A V M. The A V M nidus is indicated by an arrow. A graph of volume versus dose plots a decreasing curve with a volume and dose of around 100%.
Seven M R I scanned images of the brain labeled 6 months F forward slash U. An arrow in each scan points to a tumor on the brain.
Two M R I scanned images of the brain labeled 12 months F forward slash U. An arrow in each scan points to a tumor on the brain.
Eight M R I scanned images of the brain labeled 24 months F forward slash U. An arrow in each scan points to a tumor on the brain.
Nine M R I scanned images of the brain labeled 30 months F forward slash U. The arrows in each scan point to a tumor region on the brain.
Seven M R I scanned images of the brain labeled 112 months F forward slash U. An arrow in each scan points to a tumor region on the brain.
Two M R I scanned images of the brain labeled 113 months F forward slash U. An arrow in each scan points to a tumor region on the brain.
Three C T scanned images of the brain appear as vein-like structures labeled 120 months F forward slash U.
Six scanned images with smoky structures arranged in three columns and two rows. The two rows labeled before S R S and 120 months F forward slash U.