Management of Arteriovenous Malformations by Stereotactic Radiosurgery: A Single Center Experience

F, Dincoglan; Sager, Omer; Gamsiz, Hakan; Demiral, Selçuk; Uysal, Bora; Surenkok, Serdar; Şirin, Sait; Oysul, Kaan; Beyzadeoğlu, Mehmet Murat

doi:10.4999/uhod.11076

Cited by 18 publications

(9 citation statements)

References 26 publications

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“…SRS was performed after informed consent of the included patients and decision making for treatment with radiosurgery was decided by a multidisciplinary team of experts on neurosurgery, neuroradiology, and radiation oncology. Details of the radiosurgery procedure was described previously [8]. Briefly, a stereotactic head frame was affixed to the patients' skull under local anesthesia, supplemented with sedation if necessary.…”

Section: Methodsmentioning

confidence: 99%

“…In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs. Stereotactic Radiosurgery (SRS) has been utilized for management of several benign and malign indications with considerable success [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. In the context of AVMs, surgery offers effective management of AVMs in selected patients, however, radiosurgery may be considered when there may be an excessive risk of surgical complications for deep-seated lesions located at eloquent brain regions.…”

Section: Introductionmentioning

confidence: 99%

“…In the context of AVMs, surgery offers effective management of AVMs in selected patients, however, radiosurgery may be considered when there may be an excessive risk of surgical complications for deep-seated lesions located at eloquent brain regions. Several studies have reported 3-year obliteration rates in the order of 60% to 90%, with safe and effective management of AVMs using SRS, even for larger lesions by use of staged procedures [2,3,8,[25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

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Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Dincoglan¹,

Sager

Demiral³

et al. 2019

AJPNMS

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Background: Cerebral arteriovenous malformations (AVMs) are rarely seen congenital vascular anomalies. AVMs may lead to intracranial hemorrages due to disorganized tangle of vessels. Lifetime risk of bleeding from AVMs may be significant given the diagnosis at typically earlier ages of the lifespan, and complications associated with hemorrhage may lead to substantial morbidity or mortality. Management of AVMs aims at eliminating or reducing the risk of subsequent bleeding. In this context, microvascular surgical resection, endovascular embolization and radiosurgical treatment may be used for management of AVMs.Objective: In this study, we assessed the incorporation of Magnetic Resonance Imaging (MRI) in treatment planning for AVM radiosurgery.Â Methods: We identified 25 patients receiving radiosurgery for AVMs at our institution. Radiosurgery target volumes generated by using CT-only based imaging and CT-MR fusion based imaging for each patient were evaluated.Results: Twenty five patients undergoing SRS for AVMs were evaluated for target volume determination in this study. Mean target volume was 4.9 cc (range: 1.3-15.9 cc) on CT-only imaging, 5.7 cc (range: 1.4-16.7 cc) on CT-MR fusion based imaging, and 5.9 cc (range: 1.4-16.9 cc) on consensus decision of all treating physicians with colleague peer review. Target definition based on CT-MR fusion based imaging was identical to the consensus decision of all treating physicians in majority of patients.Conclusions: Treatment planning for AVM radiosurgery may be improved by incorporating CT-MR fusion based imaging, which clearly should be supplemented with additional data from angiography. There is need for additional studies to establish a consensus on optimal target definition by multimodality imaging for SRS of AVMs.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Dincoglan¹,

Sager

Demiral³

et al. 2019

AJPNMS

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“…Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable radiotherapeutic modality for management several benign and malign tumors throughout the human body including meningiomas, brain metastases, arteriovenous malformations, pituitary adenomas, vestibular schwannomas, cerebral cavernous malformations, craniopharyngiomas, glomus jugulare tumors, pulmonary oligometastases, and recurrent glioblastomas [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Radiosurgery In the Forms Of Stereotactic Radiosurgery (Srs)mentioning

confidence: 99%

Evaluation of Radiosurgery Target Volume Determination for Meningiomas Based on Computed Tomography (CT) And Magnetic Resonance Imaging (MRI)

Sager¹,

Dincoglan²,

Demiral³

et al. 2019

CSROA

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Objective: Meningiomas arise from arachnoid cap cells and comprise the commonest benign tumor of the brain, accounting for more than one third of all intracranial neoplasms. Surgery and radiation therapy (RT) have been traditionally used in meningioma management. Radiosurgery is a sophisticated form of therapeutic irradiation with the capability of delivering high doses of radiation to well defined targets with typically steep dose gradients around the treatment volumes under robust stereotactic localization and image guidance. Target volume definition is an important part of menigioma radiosurgery. In this study, we assessed the use of multimodality imaging for target volume definition in radiosurgery of meningiomas. Methodology:We included 27 patients receiving meningioma radiosurgery at our department. All patients were treated with high precision radiosurgery after multidisciplinary assessment of patients regarding lesion size, location, association with critical neurovascular structures, symptomatology, and previous treatments. Target volume determination was done based on using only CT images and also by incorporation of MR fusion to perform a comparative assessment. Results:Comparative evaluation revealed improved target volume definition by incorporation of MRI into radiosurgery treatment planning for patients treated with radiosurgery for meningiomas. Conclusion:Improved target definition is a pertinent goal of optimal radiosurgical treatment planning. Our study supports the utility of MRI in meningioma radiosurgery treatment planning. Clearly, further research is warranted to refine target definition for radiosurgical management of meningiomas.

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“…Details of the SRS procedure was described previ- International Journal of Hematology and Oncology ously. [17][18][19][20][21] All patients underwent high-precision SRS using a LINAC with 6-MV photons. For the first 10 years (1998-2008), XKnife-3 (Radionics, Boston, MA, USA) radiosurgery planning system was used in SRS planning and cone-based SRS was delivered by LINAC SL-25 with circular cones (Elekta, UK).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Linear Accelerator (Linac)-Based Stereotactic Radiosurgery (Srs) for The Treatment of Craniopharyngiomas

Demiral¹

2014

UHOD

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Although benign histologically, craniopharyngiomas may display clinically malignant behavior with a strong propensity for recurrence. Contemporary therapeutic approaches for craniopharyngiomas include stereotactic irradiation in the form of Stereotactic Radiosurgery (SRS) or Fractionated Stereotactic Radiation Therapy (FSRT) as part of multimodality treatment particularly when complete surgical removal is not feasible. In this study, we evaluate the use of Linear Accelerator (LINAC)-based SRS in the multidisciplinary management of patients with craniopharyngiomas. Between July 1998 and July 2013, 20 patients (11 male, 9 female) with residual or recurrent craniopharyngiomas were treated using LINAC-based SRS at Department of Radiation Oncology, Gulhane Military Medical Academy. Median age was 37 (9-69) years. Median tumor volume was 1.1 (0.9-6.9) cc. Median dose was 13 Gy (range: 10-16 Gy) prescribed to the 80%-95% isodose line encompassing the target volume. Median follow-up time was 47 (7-93) months. Overall local control rate was 88% at 1 year, 79% at 3 years and 66% at 5 years. Three and 5-year progression free survival rates were 95% and 91% whereras 3 and 5-year overall survival rates were 94% and 88%, respectively. Our study supports the usage of LINAC-based SRS as a safe and effective management strategy for patients with recurrent or residual craniopharyngiomas. ÖZET Kraniofarinjiyom Tedavisinde Lineer Akseleratör Tabanlı Stereotaktik Radyocerrahinin DeğerlendirilmesiKraniofarinjiyomlar histolojik olarak benign olsalar da rekürrens için güçlü bir eğilimle klinik olarak malign davranış sergileyebilirler. Güncel terapötik yaklaşımlar özellikle tam cerrahi rezeksiyonun uygun olmadığı durumlarda multimodal tedavinin bir parçası olarak stereotaktik radyocerrahi ya da fraksiyone stereotaktik radyoterapi şeklinde stereotaktik ışın tedavisini içermektedir. Bu çalışmada kraniofarinjiyomların multidisipliner manajmanında lineer akseleratör tabanlı stereotaktik radyocerrahinin kullanımı değerlendirilmektedir. Temmuz 1998 ile Temmuz 2013 arasında rezidüel ya da rekürren kraniofarinjiyomlu 20 hasta (11 erkek, 9 kadın) Gülhane Askeri Tıp Akademisi Radyasyon Onkolojisi Departmanında lineer akseleratör tabanlı stereotaktik radyocerrahi kullanılarak tedavi edilmiştir. Medyan yaş 37 (9-69) idi. Medyan tümör volümü 1.1 (0.9-6.9) cc idi. Hedef volümü saran %80-%95 izodoz çizgisine preskribe edilen medyan doz 13 Gy (ranj: 10-16 Gy) idi. Medyan takip süresi 47 (7-93) ay idi. Lokal kontrol oranı 1. yılda %88, 3. yılda %79, 5. yılda %66 idi. 3 ve 5 yıllık progresyonsuz sağkalım oranları sırasıyla %95 ve %91 iken 3 ve 5 yıllık toplam sağkalım oranları sırasıyla %94 ve %88 idi. Çalışmamız rekürren veya rezidüel kraniofarinjiyomlu hastalar için lineer akseleratör tabanlı stereotaktik radyocerrahinin güvenli ve etkin bir manajman stratejisi olarak kullanımını desteklemektedir.

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Management of Arteriovenous Malformations by Stereotactic Radiosurgery: A Single Center Experience

Cited by 18 publications

References 26 publications

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations

Evaluation of Radiosurgery Target Volume Determination for Meningiomas Based on Computed Tomography (CT) And Magnetic Resonance Imaging (MRI)

Evaluation of Linear Accelerator (Linac)-Based Stereotactic Radiosurgery (Srs) for The Treatment of Craniopharyngiomas

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