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Radiology Case Presentation

Radiology Case Presentation. David R. Beckert, MS-4 11/8/05. Case Background. Clinical History: 22 y.o. female presented to Neuro angio for imaging of AVM, which was discovered at OSH, in order to proceed to interventional radiology for gamma knife ablation procedure.

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Radiology Case Presentation

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  1. Radiology Case Presentation David R. Beckert, MS-4 11/8/05

  2. Case Background • Clinical History: 22 y.o. female presented to Neuro angio for imaging of AVM, which was discovered at OSH, in order to proceed to interventional radiology for gamma knife ablation procedure. • (Note: Unclear as to her original complaint that lead to the discovery of the AVM at the OSH)

  3. Radiographic Images

  4. Medium-sized AVM

  5. Blood flow to AVM from internal carotid and vertebral • Distal venous stricture also noted

  6. Arteriovenous malformations • Intracranial AVMs = 0.1% prevalence (aneurysms =1.0%). • Supratentorial lesions = 90% • Posterior fossa = 10% • AVMs account for: • 1 to 2 % of all strokes • 3 % of strokes in young adults • 9 % of subarachnoid hemorrhages

  7. AVM Clinical Summary • AVMs usually present in the second to the fourth decade of life. • Presentation: • Intracranial hemorrhage = 41-79 % • Seizures = 11-33 % • Headaches or progressive deficit • Younger patients (<30 yo) most often present with seizures, while older patients more commonly present with hemorrhage

  8. AVM Imaging • Angiography is the gold standard for the diagnosis, treatment planning, and follow-up after treatment • Anatomical and physiological information such as the nidus configuration, its relationship to surrounding vessels, and localization of the draining or efferent portion of the AVM are readily obtained • Contrast transit times provide additional useful information regarding the flow state of the lesion; this is critical for endovascular treatment planning • AVMs typically first discovered via MRI/CT • MRI- very sensitive for location purposes and following pts after treatment

  9. AVM Grading Scale

  10. AVM Treatment • Pt. Age is most important factor • Options include surgery, stereotactic radiosurgery, and endovascular embolization • Stereotactic radiosurgery — Stereotactically focused high energy beams of photons or protons to a defined volume containing the AVM nidus induces progressive thrombosis. • Time course usually one to three years, and the time between treatment and obliteration is referred to as the latency period. • Once the lesion is completely obliterated, the hemorrhage risk from the AVM is very low • Successful AVM obliteration with radiosurgery depends upon lesion size and dose of radiation (complications also depend on location/size of AVM and volume treated)

  11. References • Singer, RJ, Ogilvy, CS, Rordorf, G. Cerebral arteriovenous malformations. UpToDate Online 13.3. February 25, 2005. • Spetzler, RF, Martin, NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65:476.

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