title: Late morphological changes after radiosurgery of brain arteriovenous malformations: an MRI study.
abstract: Radiosurgery by Gamma Knife (GK) is an effective treatment for brain arteriovenous malformations (AVM). The aim of the present study was to evaluate late, radiation-induced changes detectable by MRI after AVM radiosurgery in patients treated minimally 10 years prior, with AVM obliteration proven by angiography.
  
  
  
  Thirty-five patients with 37 AVMs were included. AVMs were irradiated 16.6 ± 3.5 years prior with AVM obliteration proven 13 ± 4 years prior. All patients underwent recent MRI examinations, including application of gadolinium-based contrast.
  
  
  
  In one case, post-irradiative cystic formation with mass effect and signs of hemorrhage requiring surgery was found. Post-gadolinium enhancement at the site of obliterated nidi was apparent in 28 of 37 cases (76 %). In all cases except one, the mean volume of enhancement at the time of review was clearly lower than the volume of the originally irradiated AVM (88 ± 20 %; median 92 %); in one case the extent was 142 % greater than the irradiated AVM. When we compared enhancing and non-enhancing nidi, we found that enhancing nidi were significantly larger than non-enhancing nidi at the time of radiosurgery (4.39 ± 3.35 cc vs. 0.89 ± 0.79 cc, p = 0.004). Enhancement was not influenced by total radiation dose, patient age at the time of irradiation, duration since radiosurgery, or the number of irradiations. Wallerian degeneration was found in nine of 37 cases (24 %); in six cases the optical tracts were affected and visual field defects were proven. In five of nine cases (55.6 %) with Wallerian degeneration previous hemorrhage was present. Dual vascular pathology was found in eight of 35 patients (23 %).
  
  
  
  GK radiosurgery for AVM is a safe treatment method although delayed complications may occur. Post-gadolinium enhancement of obliterated nidi may indicate an active post-irradiative process.
authors.affiliation: Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic. hana.malikova@homolka.cz.|Institute of Anatomy, Second Medical Faculty, Charles University in Prague, U Nemocnice 3, 120 00, Prague, Czech Republic. hana.malikova@homolka.cz.
authors.forename: Hana
authors.initials: H
authors.lastname: Malikova
authors.affiliation: Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Koubska
authors.affiliation: Department of Neurology, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic.|Department of Neurology, 3rd Medical Faculty, Charles University in Prague, Ruska 87, 10000, Prague, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Vojtech
authors.affiliation: Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Weichet
authors.affiliation: Department of Pathology, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Syrucek
authors.affiliation: Department of Neurosurgery, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Sroubek
authors.affiliation: Department of Radiology, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic.
authors.forename: Aaron
authors.initials: A
authors.lastname: Rulseh
authors.affiliation: Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 15000, Prague, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Liscak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001921:Brain / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D016634:Radiosurgery / Q000009:adverse effects*
keywords: Cyst formation; Gadolinium enhancement; Post-irradiation; Wallerian degeneration