Somnath Pan2021-03-122021-03-122019-12https://dspace.sctimst.ac.in/handle/123456789/11025Brain arteriovenous malformations (AVM) are an intriguing disease entity involving the intracranial vasculature where arteries and veins are interconnected through a low resistance dysplastic nidus bypassing the normal intervening capillary network.[1] There are several morphological aspects of AVM that need to be assessed prior to planning therapeutic approach and intervention. These include location, feeding arteries, draining veins, nidus and size of the lesion.[2] The presence of feeding artery, intranidal and perinidal aneurysms, venous pouches, venous dilatations, fistulas, venous stenosis and venous thrombosis are the other factors which necessitate therapy in brain arteriovenous malformations.[3,4] An ideal imaging modality should reliably reveal these parameters. Digital subtraction angiography (DSA) very reliably predicts the presence of these varied parameters. DSA is the standard imaging procedure for AVM. However, although it gives a good impression of the spatial relationships between the vessels, it is limited by overprojection of early draining veins on arterial feeders and nidus and cannot give a true three-dimensional (3D) view from every angle. The 3D rotational angiographic (RA) images have excellent resolution, and can be rotated in any direction to show the structures from any required angle, including views that would be impossible to obtain by radiographic projections alone. An improved understanding of the 3D vascular morphology helps to ensure optimum positioning of the image intensifier during the intervention for guideline positioning of catheters, coils, balloons and stents.[5] There are few studies comparing the utility of 3D RA in cerebral aneurysm.[6,7] Hochmuth A et al., in their study have concluded that compared with DSA, 3D RA allows more exact 2 depiction of anatomic details that are important in planning surgery and interventional therapy for intracranial aneurysms and also RA depicted more aneurysms.[8] The current gold standard in imaging of brain AVM is superselective microcatheter angiography. We intended to study the effect of addition of 3D RA in better delineation of angioarchitecture of the lesions. Cerebral AVM has varied clinical presentations. Broadly it can present because of haemorrhage and unbled lesions can manifest with seizure, headache, neurodeficit or vague neurologic symptoms. Also asymptomatic lesions are detected incidentally due to neuroimaging for inexplicit symptoms. Various angiographic features like deep venous drainage, deep location, infratentorial location, distal flow related & intranidal aneurysm, previous haemorrhage has been implicated as risk factors or predictors of haemorrhagic complications.[9] Few studies have attributed manifestation of seizure in AVM to angiographic features like cortical location of feeder, feeder by MCA, absence of aneurysm, varix/varices in venous drainage.[10] Other clinical manifestations like headache and neurodeficit in unbled AVM has not been studied in relation to specific angiomorphologic attribute. Combining the 2D DSA & 3D RA is expected to generate the best possible angiomorphology of AVM. We intend to analyse the angiographic predictors for clinical manifestations of haemorrhage, seizure, headache & neurodeficit; thereby prompting necessary therapeutic intervention.enThesis