• Yuki Shinya, Hirotaka Hasegawa, Masahiro Shin, Mariko Kawashima, Takehiro Sugiyama, Osamu Ishikawa, Satoshi Koizumi, Yuichi Suzuki, Hirofumi Nakatomi, and Nobuhito Saito.
• Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
• Neurosurgery. 2021 Jun 15; 89 (1): 60-69.

BackgroundHigh-definition vascular imaging is desirable for treatment planning in Gamma Knife radiosurgery (GKRS; Elekta AB) for brain arteriovenous malformations (BAVMs). Currently, rotational angiography (RA) provides the clearest 3-dimensional visualization of niduses with high spatial resolution; however, its efficacy for GKRS has not been clarified. At our institution, RA has been integrated into GKRS (RA-GKRS) for better treatment planning and outcomes since 2015.ObjectiveTo evaluate RA-GKRS outcomes of BAVMs and compare them with conventional GKRS (c-GKRS) outcomes.MethodsWe retrospectively analyzed the radiosurgical outcomes of 50 BAVMs treated with RA-GKRS compared with the 306 BAVMs treated with c-GKRS. Considering possible differences in the baseline characteristics, we also created propensity score-matched cohorts and compared the radiosurgical outcomes between them to ensure comparability.ResultsThe obliteration time was shorter in the RA-GKRS group (cumulative rate, 88% vs 65% at 4 yr [P = .001]). Multivariate Cox proportional hazards analysis demonstrated that the RA-GKRS group (hazard ratio 2.38, 95% CI 1.58-3.60; P = .001) had a better obliteration rate. The cumulative 4-yr post-GKRS hemorrhage rates were 4.0% and 2.6% in the RA-GKRS and c-GKRS groups, respectively (P = .558). There was a trend toward early post-GKRS signal change in the RA-GKRS group compared with the c-GKRS group (cumulative rate, 38% vs 29% at 2 yr; P = .118). Those results were also confirmed in the matched cohort analyses.ConclusionThe integration of RA into GKRS is promising and may provide earlier nidus obliteration.© Congress of Neurological Surgeons 2021.

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