Shortened Cerebral Circulation Time Predicts Resistance to Obliteration in High-Flow Brain Arteriovenous Malformations After Stereotactic Radiosurgery.

Autor:	Loo JK; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan., Hu YS; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan.; Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei , Taiwan., Kao WL; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan., Yang HC; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan.; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan., Lee CC; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan.; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan., Wu HM; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan., Luo CB; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan., Guo WY; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan., Liu KD; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan.; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan., Chung WY; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan.; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan.; Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei , Taiwan., Lin CJ; Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan.; School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Dec 01; Vol. 95 (6), pp. 1429-1440. Date of Electronic Publication: 2024 Jun 20.
DOI:	10.1227/neu.0000000000003036
Abstrakt:	Background and Objectives: Treatment selection for brain arteriovenous malformations (BAVMs) is complicated by BAVM size, location, and hemodynamics. Quantitative digital subtraction angiography is used to quantify the hemodynamic impact of BAVMs on cerebral circulation. This study investigated the association between cerebral circulation time and the complete obliteration (CO) rate of BAVMs after stereotactic radiosurgery (SRS). Methods: We analyzed the data of 143 patients who underwent SRS for BAVMs between January 2011 and December 2019 in our institute. Their pre-SRS magnetic resonance imaging and angiography images were analyzed to acquire BAVM characteristics and quantitative digital subtraction angiography parameters. Modified cerebral circulation time (mCCT) was defined as the time difference between the bolus arrival time of the ipsilateral cavernous internal carotid artery and that of the parietal vein, as determined from the lateral view of images obtained using digital subtraction angiography. Cox regression with hazard ratios and Kaplan-Meier analyses were conducted to determine the associations between the parameters and BAVM CO after SRS. Results: Of the 143 patients, 101 (70.6%) achieved BAVM CO. According to the multivariate analyses, an increased mCCT (hazard ratio: 1.24, P = .041) was the independent factor associated with BAVM CO after adjustment for age, sex, hemorrhagic presentation, a BAVM volume of >5 cm 3 , and a margin dose of >18 Gy. Individuals with an mCCT of ≤2.32 s had a lower 36-month probability of BAVM CO than did those with an mCCT of >2.32 s (44.1% ± 6.8% vs 63.3% ± 5.6%, P = .034). Conclusion: The hemodynamic impact of high-flow BAVM demonstrated by a shortened mCCT is associated with a lower BAVM CO rate after SRS. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu