title: Angioarchitecture and Posttreatment Magnetic Resonance Imaging Characteristics of Brain Arteriovenous Malformations and Long-Term Seizure Control After Radiosurgery.
abstract: OBJECTIVE
  To corroborate which pretreatment angioarchitectural characteristics and posttreatment magnetic resonance imaging (MRI) features were associated with better seizure and antiepileptic drug outcomes in patients with brain arteriovenous malformations (AVMs) treated by Gamma Knife radiosurgery.
  
  
  METHODS
  During the period 2007-2010, 220 patients with intracranial AVMs undergoing radiosurgery at our hospital were evaluated. Imaging features on digital subtraction angiography and follow-up MRI, medical records, and direct patient interview were retrospectively assessed. Seizure outcome was assessed using the Engel classification and the status of antiepileptic drug use.
  
  
  RESULTS
  At the last follow-up, 21 of 31 patients (68%) who met the recruitment criteria had AVM obliteration on digital subtraction angiography or MRI. Seizure-free status (Engel class 1) was achieved in 20 patients (65%), and 13 of 20 (65%) seizure-free patients were medication-free. The presence of total obliteration at last imaging follow-up (P = 0.013), absent retrograde cortical veins on digital subtraction angiography before GKRS (P = 0.013), nidus <3.7 cm (P = 0.006), and lower modified radiosurgery-based AVM score (P = 0.026) were significant predictors of seizure-free outcome. The strongest independent predictor of seizure-free status was absence of retrograde veins (odds ratio = 9.9). No angioarchitectural feature, postradiosurgery imaging finding on MRI, or radiosurgical treatment parameter was a significant predictor of seizure control or cessation of medication in seizure-free patients.
  
  
  CONCLUSIONS
  This study suggests that radiosurgery provides favorable outcomes in patients with AVM-related epilepsy. Patients with intracranial AVMs can benefit from seizure control after GKRS before undergoing AVM obliteration. Absence of retrograde veins is associated with better seizure-free outcomes, regardless of the parenchymal changes after radiosurgery.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. Electronic address: wyguo@vghtpe.gov.tw.
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Yuh
authors.initials: WY
authors.lastname: Chung
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hsiu-Mei
authors.initials: HM
authors.lastname: Wu
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D000927:Anticonvulsants / Q000627:therapeutic use; D002533:Cerebral Angiography; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Angioarchitecture; Arteriovenous malformation; Gamma Knife radiosurgery; MRI; Seizure outcome