Treating Arteriovenous Malformation With Stereotactic Radiosurgery Using CT Angiography for Treatment Planning
Treating Arteriovenous Malformation With Stereotactic Radiosurgery Using CT Angiography for Treatment Planning
Evaluate whether a treatment plan based on CT angiography can accurately and precisely
 identify the target nidus as compared to standard cerebral arteriography fused to MRI.
Stereotactic Radiosurgery is a preferable treatment option for patients with Arteriovenous
 malformation (AVM) that are not surgically accessible or in patients with comorbidities that
 make them poor surgical candidates At University of Texas Southwestern Medical Center (UTSW),
 investigator routinely perform interventional cerebral arteriography on the day of the SRS
 procedure for improved target delineation. Even though the addition of angiography is time
 consuming and requires multi-modality team care, this approach has allowed UTSW to treat the
 smallest possible target, yet achieve excellent obliteration rates of AVM with very low
 toxicity from the procedure. At UTSW the investigator also use CT angiogram at the treatment
 team's discretion to further enhance the accurate delineation of the final treatment target
 volume. However, it had not been routinely done due to uncertain benefit in treatment
 planning and a concern for renal burden from additional intravenous (IV) contrast usage.

 This prospective enrollment and conduct open-label, retrospective analysis study is to
 evaluate whether a target volume based on CT angiography can serve as a reliable substitute
 for a target based on interventional cerebral arteriography. Patients on this protocol will
 still get treated based on target generated by interventional cerebral arteriography but also
 receive CT angiography. If the target volume based on CT angiography are adequate compared to
 their invasive counterpart, future investigators may selectively omit performing
 interventional cerebral arteriography in the treatment planning for SRS of AVM. Use of CT
 angiography may lead to reduction in the risk from the procedure and cost, improve the
 efficiency of the treatment process ideally without compromising the success of the
 procedure, with greater patient comfort and satisfaction.
Inclusion Criteria:

 1. Documented AVM with draining vein(s).

 2. Adequate renal function (within 30 days) to undergo contrast CT and interventional
 cerebral arteriography on the same day, as determined by treating physicians.

 3. AVM must be physically separated from the optic pathway, brainstem or spinal cord.

 4. The maximum diameter of AVM nidus must be less than 3.5 cm and/or less than 12 cc.

 5. Age ≥ 10 years.

 6. Women of child-bearing potential and men must agree to use adequate contraception
 (hormonal or barrier method of birth control; abstinence) at least three weeks prior
 and three weeks after the SRS procedure.

 6.1 A female of child-bearing potential is any woman (regardless of sexual
 orientation, having undergone a tubal ligation, or remaining celibate by choice) who
 meets the following criteria:

 -  Has not undergone a hysterectomy or bilateral oophorectomy; or

 -  Has not been naturally postmenopausal for at least 12 consecutive months (i.e.,
 has had menses at any time in the preceding 12 consecutive months).

 6.2 Negative urine hCG test (within 30 days) for female of child-bearing potential.

 7. Ability to understand and the willingness to sign a written informed consent.

 Exclusion Criteria:

 1. Patients without a documented AVM.

 2. Patients with a contraindication to CT or MRI such as contrast allergy, kidney failure
 or implanted metal devices or foreign bodies or severe claustrophobia.

 3. Use of Nephrotoxic drugs, such as gentamycin, high-dose nonsteroidal anti-inflammatory
 drugs, or certain chemotherapeutic drugs within 10 days of the procedure.

 4. Recent (within 10 days) or ongoing urinary tract infection (UTI).

 5. Psychiatric illness/social situations that would limit compliance with study
 requirements.

 6. Patients must not be pregnant at the time of SRS treatment.