Keywords

  • Demographics: Male; 14 years

  • Initial Presentation: Hemorrhage (intraventricular), which occurred twice; at 2 years and 8 months before radiosurgery treatment

  • Diagnosis: Basal ganglia AVM

  • Pre-radiosurgery Treatment: None

  • Pre-radiosurgery Presentation: Asymptomatic and neurologically intact, after complete recovery from coma induced by last hemorrhage

  • Radiosurgery Treatment:

    Upfront (primary); Linac-based SRS for right basal ganglia (lentiform nucleus) AVM

  • Radiosurgery Dosimetry:

    • Target volume: 3.2 cc

    • Marginal dose: 18.0 Gy

    • Marginal isodose: 80%

    • Maximum dose: 39.8 Gy

    • Minimum dose: 14.2 Gy

    • Average dose: 26.7 Gy

    • Number of isocenters: 2

    • Maximum dose to brain stem: 6.7 Gy

  • Follow-Up Period: 65 months post-SRS

  • Clinical Outcome: Asymptomatic and neurologically intact throughout the entire follow-up period

  • Complications: None

  • Radiological Outcome:

    • 7 months post-SRS (MRI and MRA): Stationary size of AVM nidus

    • 14 months post-SRS (MRI):

      • Marked decrease in size of AVM nidus

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

    • 25 months post-SRS (MRI):

      • Non-visualized AVM nidus

      • Resolving right periventricular perinidal high signal in T2 and FLAIR studies

      • Appearance of right periventricular focal encephalomalacia, showing minimal enhancement in T1 Gadolinium-enhanced study, at the site of prior AVM nidus

    • 65 months post-SRS (CTA): Complete obliteration of AVM nidus

  • Post-radiosurgery Treatment: None

Nine C T scans represent the transverse before the S R S stage of basal ganglia A V M.
Four C T scans represent the before S R S scans of the cerebrum confirming a region of A V M in the middle of the right cerebral hemisphere.
Three scans and 3 angiographs of the cerebrum of the arteriovenous nexus.
Four C T scans of the brain, two Iso-centric plans, 18 G y at 80 percent isodose line, and a treatment plan. The graph represents the volume versus dose with slices from 30 to 41.
Seven C T scans and three angiographs of the brain depict the seventh month F U basal ganglia A V M in the right cerebral hemisphere.
Six transverse C T scans represent the lateral C T scan of the cerebrum, confirming a region of A V M in the right cerebral hemisphere.
Seven C T scans represent cerebral confirm a region of basal ganglia A V M in the middle of the right cerebral hemisphere
Eight C T scans, of which four before S R S are on the left and four 25 months F U stage are on the right.
3 scans represent the 65-month F U and 3 cerebral angiographies exhibit the basal ganglia arteriovenous nexus.
Three scans before S R S are on the left and three 65 months F U angiography are on the right.