A multicenter retrospective study of frameless robotic radiosurgery for intracranial arteriovenous malformation.

Abstract

INTRODUCTION:

CT-guided, frameless radiosurgery is an alternative treatment to traditional catheter-angiography targeted, frame-based methods for intracranial arteriovenous malformations (AVMs). Despite the widespread use of frameless radiosurgery for treating intracranial tumors, its use for treating AVM is not-well described.

METHODS:

Patients who completed a course of single fraction radiosurgery at The University of North Carolina or Georgetown University between 4/1/2005-4/1/2011 with single fraction radiosurgery and received at least one follow-up imaging study were included. All patients received pre-treatment planning with CTA ± MRA and were treated on the CyberKnife (Accuray) radiosurgery system. Patients were evaluated for changes in clinical symptoms and radiographic changes evaluated with MRI/MRA and catheter-angiography.

RESULTS:

Twenty-six patients, 15 male and 11 female, were included in the present study at a median age of 41 years old. The Spetzler-Martin grades of the AVMs included seven Grade I, 12 Grade II, six Grade III, and one Grade IV with 14 (54%) of the patients having a pre-treatment hemorrhage. Median AVM nidal volume was 1.62 cm(3) (0.57-8.26 cm(3)) and was treated with a median dose of 1900 cGy to the 80% isodose line. At median follow-up of 25 months, 15 patients had a complete closure of their AVM, 6 patients had a partial closure, and 5 patients were stable. Time since treatment was a significant predictor of response, with patients experience complete closure having on average 11 months more follow-up than patients with partial or no closure (p = 0.03). One patient experienced a post-treatment hemorrhage at 22 months.

CONCLUSION:

Frameless radiosurgery can be targeted with non-invasive MRI/MRA and CTA imaging. Despite the difficulty of treating AVM without catheter angiography, early results with frameless, CT-guided radiosurgery suggest that it can achieve similar results to frame-based methods at these time points.

• Authors: Eric K Oermann, Nikhil Murthy, Viola Chen, Advaith Baimeedi, Deanna Sasaki-Adams, Kevin McGrail, Sean P Collins, Matthew G Ewend, Brian T Collins
• Journal: Frontiers in oncology (Front Oncol) Vol. 4 Pg. 298 ( 2014) ISSN: 2234-943X [Print] Switzerland
• PMID: 25414830 (Publication Type: Journal Article)