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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurointervention

Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery

Y.-S. Tsuei, C.-B. Luo, L.-Y. Fay, H.-C. Yang, W.-Y. Guo, H.-M. Wu, W.-Y. Chung and M.M.H. Teng
American Journal of Neuroradiology April 2019, 40 (4) 675-680; DOI: https://doi.org/10.3174/ajnr.A6018
Y.-S. Tsuei
aFrom the Department of Neurosurgery (Y.-S.T.), Taichung Veterans General Hospital, Taichung, Taiwan
bDepartments of Neurosugery (Y.-S.T.)
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C.-B. Luo
cRadiology (C.-B.L.), Tri-Service General Hospital, National Defenses Medical Center, Taipei, Taiwan
dDepartments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
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L.-Y. Fay
eNeurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
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H.-C. Yang
eNeurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
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W.-Y. Guo
dDepartments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
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H.-M. Wu
dDepartments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
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W.-Y. Chung
eNeurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
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M.M.H. Teng
dDepartments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
fDepartment of Radiology (M.M.H.T.), Cheng-Hsin General Hospital, Taipei, Taiwan.
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  • Fig 1.
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    Fig 1.

    Left, The patient had a right parieto-occipital brain arteriovenous malformation with a small flow-related aneurysm (arrow) at the right medial paraclinoid internal carotid artery. Right, Conventional angiography at 54 months after stereotactic gamma knife surgery demonstrates almost total obliteration of the BAVM but no obvious morphologic change in the proximal FA.

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    Fig 2.

    Left, The patient had a right frontotemporal BAVM and small proximal FAs at the M1 segment of the right middle cerebral artery (arrows). Right, Conventional angiography at 38 months after GKS demonstrates almost total regression of the proximal FAs.

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    Fig 3.

    Left, The patient had a right inferior temporal BAVM and 2 distal FAs at the M2 segment of the right middle cerebral artery (arrows). Right, Conventional angiography at 37 months after GKS demonstrates total obliteration of the distal FAs with normalization of blood flow through the feeders to the BAVM and FAs.

Tables

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    Table 1:

    Demographics of patients with BAVMs enrolled and characteristics of FAs

    Value
    No. of eligible patients936
    No. of excluded patients113
        No. of patients with <50% obliteration of BAVM39
        No. of patients without DSA follow-up57
        No. of interventions of FAs17
    No. of patients enrolled823
    No. of patients with FAs enrolled72 (8.8%)
    Mean age (yr)43 (range, 18–72)
    Sex (No.)
        Female29 (40%)
        Male43 (60%)
    No., location, and size of FAs (mm)
        Total No. of FAs (mean size)111 (4.1)
        Mean size of proximal FAs4.3
        Mean size of distal FA3.7
    No. of FAs per patient1.5
    No. of FAs in supratentorium98
        No. of FAs in ICA42
        No. of FAs in proximal/distal MCA16/14
        No. of FAs in proximal/distal ACA9/17
    No. of FAs in infratntorium13
        No. of proximal FAs5
        No. of distal FAs8
    • View popup
    Table 2.

    Demographics of 111 FAs in 72 patients with BAVMs after radiosurgerya

    ParametersStable FAs (n = 60)Regressive FAs (n = 51)P Value
    Sex.70
        Male (n = 43)35 (57)27 (44)
        Female (n = 29)25 (51)24 (49)
    Mean age of patients (yr)41 ± 1044 ± 15.21
    Mean volume of BAVM (mL)36 ± 940 ± 12.048b
    Mean size of FAs (mm)4.5 ± 0.93.6 ± 0.5.0001b
    No. of ruptured/unruptured BAVMs.85
        Ruptured (n = 31)26 (55)21 (45)
        Unruptured (n = 41)34 (53)30 (47)
    No. of complete/incomplete obliteration of BAVMs.29
        Complete (n = 52)41 (51)40 (49)
        Incomplete (n = 20)19 (63)11 (37)
    • ↵a Data are means. Numbers in parentheses do not add up to 100% due to rounding. Data in parentheses are percentages.

    • ↵b P < .05, indicates statistical significance.

    • View popup
    Table 3:

    Location and morphologic change of FAs of BAVMsa

    Location of FANo. of FAsNo. of Stable FAsNo. of Regressive FAs/Total RegressionP Value of Regression in Proximal and Distal FAs
    Supratentorium9856 (57)42 (43)/20 (20)
        ACA26
            Proximal (%)95 (56)4 (44)/1 (11).19
            Distal (%)174 (24)13 (76)/8 (47)
        MCA30
            Proximal (%)1610 (63)6 (38)/2 (13).01
            Distal (%)142 (14)12 (86)/9 (62)
        ICA (proximal)4235 (83)7 (17)/0 (0)NA
    Infratentorium13
        Proximal43 (75)1 (25)/1 (25).052
        Distal91 (11)8 (89)/5 (56)
    Overall11160 (54)51 (46)/26 (23)
            Proximal (%)7153 (75)18 (25)/4 (6)<.001b
            Distal (%)407 (18)33 (83)/22 (55)
    • Note:—NA indicates not available.

    • ↵a Data in parentheses are percentages. Numbers in parentheses do not add up to 100% due to rounding.

    • ↵b P < .05, indicates statistical significance.

    • View popup
    Table 4:

    Size and morphologic change of FAs of BAVMsa

    Location of FANo. of FAsNo. of Stable FAsNo. of Regressive FAs/Total RegressionP Value of Regression in Small FAs (<5 mm)
    Supratentorium9856 (57)42 (43)/20 (20)
        ACA26
            <5 mm (%)269 (35)17 (65)/13 (50)NA
            ≥5 mm (%)00 (0)0 (0)
        MCA30
            <5 mm (%)259 (36)16 (64)/9 (36).36
            ≥5 mm (%)53 (60)2 (40)/0 (0)
        ICA42
            <5 mm (%)3629 (80)7 (19)/0 (0).57
            ≥5 mm (%)66 (100)0 (0)
    Infratentorium133 (25)9 (75)/2 (17).31
         <5 mm (%)12
        ≥5 mm (%)11 (100)0 (0)
    Overall11160 (54)51 (46)/26 (23).036b
         <5 mm (%)9950 (51)49 (49)/26 (26)
        ≥5 mm (%)1210 (83)2 (17)/0 (0)
    • ↵a Data in parentheses are percentages. Numbers in parentheses do not add up to 100% due to rounding.

    • ↵b P < .05, indicates statistical significance.

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American Journal of Neuroradiology: 40 (4)
American Journal of Neuroradiology
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1 Apr 2019
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Y.-S. Tsuei, C.-B. Luo, L.-Y. Fay, H.-C. Yang, W.-Y. Guo, H.-M. Wu, W.-Y. Chung, M.M.H. Teng
Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery
American Journal of Neuroradiology Apr 2019, 40 (4) 675-680; DOI: 10.3174/ajnr.A6018

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Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery
Y.-S. Tsuei, C.-B. Luo, L.-Y. Fay, H.-C. Yang, W.-Y. Guo, H.-M. Wu, W.-Y. Chung, M.M.H. Teng
American Journal of Neuroradiology Apr 2019, 40 (4) 675-680; DOI: 10.3174/ajnr.A6018
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