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Objective: To investigate whether angiograms obtained 2 years after radiosurgery, proving total arteriovenous malformation (AVM) occlusion, represent the final state of treated AVMs and adjacent normal vessels., Methods: Angiograms were obtained for 48 patients 5 to 24 years after gamma knife radiosurgery and 4 to 17 years after the AVMs had been proven to be totally occluded after the treatment; changes in normal vessels and signs of recanalization were recorded. Ten of the patients developed clinical symptoms attributable to the AVMs or the treatment after having been declared cured, whereas the other patients did not exhibit symptoms., Results: There was evidence of AVM nidi at the sites of previously occluded AVMs for two patients and of nidi adjacent to those sites for another two patients. Three of the four recurrent AVMs were associated with hemorrhaging. All patients who experienced hemorrhaging from previously occluded AVMs were < or = 14 years of age at the time of gamma knife radiosurgery. There were signs of segmental narrowing in normal vessels that had been irradiated with high doses (nine patients) or a low dose (one patient). The segmental narrowing decreased with time for four of these patients, was unchanged for four, and increased for two. These vascular changes did not produce clinical symptoms in any of the patients., Conclusion: There is a small possibility that AVMs may reappear after having been totally occluded after radiosurgery, especially in pediatric patients. Segmental narrowing in normal arteries after radiosurgery is a benign condition that rarely progresses and does not produce clinical symptoms.

A simple system for cerebral angiography under stereotactic conditions using standard components is described. X-ray tubes and power generator belong to the usual equipment of the stereotactic operating room. A film changer and an injection pump were integrated into the stereotactic arrangement. Angiographic documents with reduced X-ray magnification were obtained. For topographical orientation 5 films per seriogram were sufficient. The system also allows stereoscopic viewing by performing an additional oblique sequence after the head ring is rotated exactly 6 degrees. The combination of the necessary diagnostic procedures, as CT scan, angiography, ventriculography, serial biopsy within a single three coordinate reference system offers considerable advantages for brain tumour patients.