CyberKnife Ablation for Intramedullary Spinal Cord Arteriovenous Malformations (AVMs): A New Promising New Therapeutic Approach

Adler, John R.; Gupta, Gaurav; Chang, Steven D.; Soltys, Scott G.; Gibbs, Iris C.; Edwards, Michael B.; Dodd, Robert

doi:10.7759/cureus.14

Cited by 8 publications

(9 citation statements)

References 43 publications

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“…Importantly, the hemorrhage risk increased to 10 % for patients with spinal AVMs with previous hemorrhages. In spinal AVM cases treated with radiotherapy, no case experienced rebleeding, although complete nidus obliteration was not achieved [11,[16][17][18]. In our study, no patient suffered from rebleeding, although the shorter follow-up periods warrant care in interpreting such results, and indeed, further follow-up is required.…”

Section: Radiosurgery For Hemorrhagic Casescontrasting

confidence: 67%

“…Other studies report the administration of higher radiation doses (Table 3) [11,17]. For example, a recent report from Stanford University included 30 patients with spinal AVM who were treated between 1997 and 2008 (mean follow-up, 63 months) [17]. BED in that study was generally higher than These two articles shared patients' information that in our study and was as high as 180 Gy in a few cases (Table 3).…”

Section: Radiation Dosementioning

confidence: 50%

“…They achieved complete AVM obliteration and significant reductions of nidus volumes in 8 and 11 cases, respectively. Moreover, they showed that higher radiosurgical doses induced greater obliteration of intramedullary AVM, although this positive relationship was not statistically significant [17].…”

Section: Radiation Dosementioning

confidence: 89%

“…For example, Kirkpatrick et al found that a dose of 13 Gy in a single fraction or 20 Gy in three fractions for the spinal cord was associated with <1 % risk of spinal cord injury [19]. In the study conducted at Stanford University, three patients clinically deteriorated [17] and two received BED equivalent to 120 Gy. The other patient underwent repeated radiosurgery over 3 years.…”

Section: Risks and Benefitsmentioning

confidence: 97%

“…The rationale for our dose selection was based on skepticism that higher radiation doses would lead to radiation necrosis, which would be disastrous. Other studies report the administration of higher radiation doses (Table 3) [11,17]. For example, a recent report from Stanford University included 30 patients with spinal AVM who were treated between 1997 and 2008 (mean follow-up, 63 months) [17].…”

Section: Radiation Dosementioning

confidence: 97%

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Stereotactic radiosurgery as a feasible treatment for intramedullary spinal arteriovenous malformations: a single-center observation

et al. 2016

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Spinal cord intramedullary arteriovenous malformations are rare. For patients suffering from either hemorrhage or myelopathy, surgical or endovascular interventions are indicated. However, complete eradication of the nidus is often difficult because of its intramedullary location and complex angioarchitecture. In this report, we evaluate the feasibility and safety of stereotactic radiosurgery as a treatment modality for intramedullary spinal arteriovenous malformations (AVMs). Between 2010 and 2014, we performed stereotactic radiosurgery to treat four patients with intramedullary AVM and one with spinal arteriovenous metameric syndrome (one woman and four men; age range, 31-66 years). Three patients presented with myelopathy, and two suffered hemorrhages. Nidi were located in the cervical (three cases) and thoracic (two cases) spinal cord regions. Based on the angioarchitecture, surgery and endovascular embolization were indicated. When both modalities were deemed hazardous, radiosurgery using CyberKnife™ was offered. Radiation using marginal doses of 18 Gy was administered in three fractions. The mean follow-up period was 37.2 months (range, 16-62 months). After treatment, two of the three patients with myelopathy experienced either improvement or stabilization of their symptoms and one experienced worsening of dysesthesia. In two patients with hemorrhage, symptoms improved in one and remained stable in the other. No further hemorrhagic episodes were evident during follow-up. Follow-up angiograms showed marked shrinkage of the nidus located in the thoracic spinal cord in one case and angiographic stabilization in the others. As a treatment modality for intramedullary AVMs, CyberKnife™ is safe and can be considered when surgery or endovascular therapy is not indicated. To determine optimum radiation doses and protocols for treating spinal AVMs, further studies with more patients and long-term follow-up are required.

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Section: Radiosurgery For Hemorrhagic Casescontrasting

confidence: 67%