Stereotactic Heavy-Charged-Particle Bragg-Peak Radiation for Intracranial Arteriovenous Malformations

Steinberg, Gary K.; Fabrikant, Jacob I.; Marks, Michael P.; Levy, Richard P.; Frankel, Kenneth A.; Phillips, Mark H.; Shuer, Lawrence M.; Silverberg, Gerald D.

doi:10.1056/nejm199007123230205

Cited by 289 publications

(157 citation statements)

References 18 publications

Supporting

Mentioning

146

Contrasting

Unclassified

Order By: Relevance

“…Previous studies on intracranial AVMs have reported that the risk of hemorrhage during the latency period decrease [37][38], remains unchanged [36,39], or even increases [15,40] when compared with the natural course of the disease. Of note, these prior cerebral AVM studies tended to compare the risk of hemorrhage among selected patients who underwent radiosurgery with patients who did not undergo radiosurgery; in contrast, the present series analyzed changes in the rate of hemorrhage pre-and post-radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

“…The selection of radiation dose throughout this series was the product of a complex calculus that drew upon an extensive radiosurgical experience with cerebral AVMs in critical deep brain regions [15], and later on, a growing understanding of the risks and benefits of using different doses to manage a range of intra-and extra-axial vascular and non-vascular spinal lesions [16]. At the initiation of this study, there was no prior experience with treating spinal lesions with radiosurgery.…”

Section: Radiosurgical Dosagementioning

confidence: 99%

See 1 more Smart Citation

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

Adler¹,

Gupta²,

Chang³

et al. 2010

Cureus

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Radiosurgical Dosagementioning

confidence: 99%

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

Adler¹,

Gupta²,

Chang³

et al. 2010

Cureus

View full text Add to dashboard Cite

“…Lunsford et al 7 stated that 16% of the 207 patients they treated needed mild analgesia to control postoperative headaches. Steinberg and colleagues, 8 documented 40 patients with preoperative headaches. Twenty-seven percent exhibited no change after surgery, while 5% had worsening of symptoms.…”

Section: Commentsmentioning

confidence: 99%

“…2 All current studies relate AVM obliteration with relief of presurgical headaches. 2,4 Steinberg et al 8 proposed that after the collapse of the AVM nidus there is an improvement in regional cerebral blood flow, or normalization of hemodynamics. Coffey and associates 5 documented that 71% of AVMs which were greater than 10 cm 3 needed between 2 to 3 years before complete angiographic obliteration.…”

Section: Commentsmentioning

confidence: 99%

Post Gamma Knife Headache: A New Headache Syndrome?

Rozen

Swanson

1997

Headache

View full text Add to dashboard Cite

Gamma knife surgery has become an effective alternative to microsurgery in the treatment of cerebral arteriovenous malformations. In a number of patients, a de novo headache syndrome has been produced after gamma knife surgery. A case report is presented of a 62-year-old man who developed a migrainous type headache 15 months after gamma knife surgery. The current neurosurgical literature has very poor documentation of postsurgical headaches. A review of the literature was made to try to identify a stereotypic "post gamma knife headache," as well as hypothesize about its mechanism of induction.Key words: headache, gamma knife surgery, stereotactic radiosurgery, arteriovenous malformation, nigraine Abbreviations: AVM arteriovenous malformation (Headache 1997;37:180-183) Stereotactic radiosurgery has become an effective alternative to microsurgery in the treatment of cerebral arteriovenous malformations (AVMs). As of January 1993, over 4500 patients with AVMs have been treated with gamma knife surgery. 1 The goal of the gamma knife is to obliterate the AVM nidus via "endothelial cell proliferation, progressive vessel wall thickening, and eventual luminal closure." 2 Headaches are a well-known manifestation of cerebral vascular malformations. 3 Microsurgery, as well as gamma knife surgery, is being used in some instances, solely, to help ameliorate headaches produced by an AVM. 4 In recent reports, a number of patients treated with stereo-tactic surgery have been shown to have an exacerbation of their presurgical headache after use of the gamma knife. 2 In addition, a de novo headache syndrome has following this type of radiosurgery in some individuals. 4 The extent of headache development as a side effect of stereotactic radiosurgery is not well documented. More importantly, in the reports of postsurgical headaches, no mention has been made of the characteristics of the head pain syndrome.A patient is presented who developed a migrainous type headache after treatment of an occipital AVM with gamma knife surgery. A review of the current neurosurgical literature was made in an attempt to identify a stereotypic "post gamma knife headache" as well as hypothesize on its mechanism of induction. CASE HISTORYA 62-year-old, right-handed man, with a 30-year history of alcohol abuse, was brought to the emergency department in a confused state. The patient was found sitting in his kitchen, with blood on the floor near his chair. He complained of a mild frontal headache. He had been drinking alcohol earlier that morning, and had no recall of the previous events.On admission to the hospital, he had bilateral periorbital ecchymoses. The remainder of the physical examination was normal. Neurologic examination was nonfocal, except for the presence of a right inferior homonymous hemianopsia. A CT scan of the head revealed a left occipital AVM. There was no evidence that the AVM had bled or of a skull fracture. The patient had a normal sleep and wake EEG. A cerebral angiogram revealed a high flow, high shunt AVM involving the left...

show abstract

“…At the University of California at Berkeley -Lawrence Berkeley Laboratory (UCB-LBL) we have. developed stereotactic heavy-charged-particle Bragg peak radiosurgery for treatment of symptomatic surgicallyinaccessible intracranial arteriovenous malformations (AVMs) [1][2][3][4][5][6][7][8][9][10]. Narrow beams of accelerated helium ions are directed stereotactically to defined intracranial targets.…”

Section: Introductionmentioning

confidence: 99%

Heavy-Charged-Particle Radiosurgery for Intracranial Arteriovenous Malformations

Fabrikant

Levy²,

Steinberg³

et al. 1991

Stereotact Funct Neurosurg

Self Cite

View full text Add to dashboard Cite

We have treated over 400 patients with symptomatic inoperable intracranial arteriovenous malformations (AVMs) with stereotactic heavy-charged-particle Bragg peak radiosurgery at the University of California at Berkeley in a collaborative program with Stanford University Medical Center and the University of California Medical Center, San Francisco. A long-term dose-searching clinical trial protocol has been developed and we have followed more than 250 patients for more than 2 years. Initially, radiation doses ranged from 45 to 35 GyE, and now doses of 25, 20, 15 and, under special circumstances, 10 GyE, depending on a number of factors, are being evaluated. The characteristics of charged-particle beams provide a relatively homogeneous dose distribution with the 90% isodose contour to the periphery of the lesion. When the entire arterial phase of the AVM core is included in the treatment field, the rates for complete obliteration 3 years after treatment are: 90–95% for volumes ≤4 cm³; 90–95% for volumes > 4 and ≤14 cm³; and 60–70% for volumes > 14 cm³. The total obliteration rate for all volumes up to 70 cm³ is approximately 80–85%. For complete radiation-induced obliteration there is a relationship of dose and volume primarily, and location secondarily. Results on relationships between dose, AVM obliteration, and complications and sequelae of the radiosurgical procedure are presented and discussed.

show abstract

Stereotactic Heavy-Charged-Particle Bragg-Peak Radiation for Intracranial Arteriovenous Malformations

Cited by 289 publications

References 18 publications

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

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

Post Gamma Knife Headache: A New Headache Syndrome?

Heavy-Charged-Particle Radiosurgery for Intracranial Arteriovenous Malformations

Contact Info

Product

Resources

About