Tube angulation improves angiographic targeting of arteriovenous malformations during stereotactic radiosurgery

Stereotactic radiosurgery using the 201 Cobalt-60 source Gamma Knife has been an effective method for obliterating selected cerebral arteriovenous malformations (AVMs). For more than 20,000 patients worldwide, angiography under stereotactic conditions has been the main imaging modality for defining and targeting the AVM nidus. The role of angulation of the X-ray tube for angiographic localization of the AVM during stereotactic Gamma Knife radiosurgery was studied with a phantom. Using current dose-planning software, tube angulation facilitated target visualization, improved three-dimensional dose planning, and has been consistent with the increased probability of complete nidus obliteration.