Optimizing 3D Cerebral Angiographic Imaging Techniques for Gamma Knife Radiosurgery: Technical Considerations for Arteriovenous Shunt Treatment

3D cerebral angiographic imaging offers superior spatial resolution and flexible acquisition compared with CTA, enabling selective injections and dynamic phase selection¹⁻⁴. Its application in gamma knife radiosurgery has been increasingly recognized, particularly for arteriovenous shunts, where precise visualization of angioarchitecture is essential.⁵⁻¹² We describe strategies for incorporating 3D rotational angiography and conebeam CT into treatment planning, highlighting their respective strengths and limitations.⁷,⁸,¹²,¹³⁻¹⁶ Imaging can be performed either before or after frame fixation, each approach carrying unique advantages and constraints.¹⁹,²⁰ Postprocessing-targeted reconstruction, MIP/MPR, subtraction imaging, and metal-artifact reduction-further refines visualization, highlighting the complementary value of each technique.¹⁷,¹⁸ These tools enhance confidence in nidus delineation and planning accuracy. Collaboration with endovascular specialists is critical for optimal acquisition and data sharing. This video presents technical considerations and practical tips to optimize the clinical use of 3D angiographic imaging in gamma knife radiosurgery for arteriovenous shunt management.