AN EXPERIMENTAL COMPARTMENTAL FLOW MODEL FOR ASSESSING THE HEMODYNAMIC-RESPONSE OF INTRACRANIAL ARTERIOVENOUS-MALFORMATIONS TO STEREOTAXIC RADIOSURGERY

被引:34
作者
LO, EH
FABRIKANT, JI
LEVY, RP
PHILLIPS, MH
FRANKEL, KA
ALPEN, EL
机构
[1] UNIV CALIF BERKELEY LAWRENCE BERKELEY LAB,BERKELEY,CA 94720
[2] UNIV CALIF SAN FRANCISCO,DEPT RADIOL,SAN FRANCISCO,CA 94143
关键词
ARTERIOVENOUS MALFORMATION; CEREBRAL HEMODYNAMICS; COMPARTMENTAL FLOW MODEL; REGIONAL CEREBRAL BLOOD FLOW; STEREOTAXIC RADIOSURGERY;
D O I
10.1227/00006123-199102000-00012
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Stereotactic radiosurgery has proven to be an effective method of treating selected inaccessible or inoperable arteriovenous malformations (AVMs) of the brain. Radiation-induced obliteration of successfully-treated AVMs, however, occurs only after some latent period after treatment, depending on size, location, and dose. An experimental compartmental flow model is proposed to describe the hemodynamic alterations in the AVM as a result of the pathophysiological changes after radiosurgery, and to analyze temporal alterations in AVM blood flow rates and pressure gradients before complete obliteration. In representative small (low-flow, 150 ml/min) and large (high-flow, 440 ml/min) AVMs, it is found that increases in pressure gradients across certain vascular structures within the AVM occur during the normal course of radiation-induced flow decrease and AVM obliteration. The magnitude of these pressure alterations, however, may be within the normal physiological variations in cerebrovascular blood pressure. The effects of partial-volume irradiation of the AVM is examined by limiting radiosurgical treatment to varying portions of the flow compartments within the model. It is found that alterations in pressure gradients persist in unirradiated vascular shunts, even after complete obliteration of the treated AVM volume. These pressure alterations may increase the probability of hemorrhage from the untreated shunts of the AVM and cause redistribution of regional cerebral blood flow resulting in increased flow through these untreated shunts.
引用
收藏
页码:251 / 259
页数:9
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