Magnetic Resonance Imaging-Based Robotic Radiosurgery of Arteriovenous Malformations

Frontiers in Oncology

Jun Thorsteinsdottir¹  Christian Schichor¹  Tobias Greve¹  Joerg-Christian Tonn¹  Viktor Švigelj²  Anita Resman-Gašperšič²  Alexander Muacevic³  Theresa Hofmann³  Felix Ehret³  Franziska Dorn⁴ 

[1] Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany;Division of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia;European Cyberknife Center Munich-Grosshadern, Munich, Germany;Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany;

关键词: CyberKnife;    radiosurgery;    stereotactic;    arteriovenous malformation;    Gammaknife surgery;   

DOI  :  10.3389/fonc.2020.608750

来源: DOAJ

【 摘 要 】

ObjectiveCyberKnife offers CT- and MRI-based treatment planning without the need for stereotactically acquired DSA. The literature on CyberKnife treatment of cerebral AVMs is sparse. Here, a large series focusing on cerebral AVMs treated by the frameless CyberKnife stereotactic radiosurgery (SRS) system was analyzed.MethodsIn this retrospective study, patients with cerebral AVMs treated by CyberKnife SRS between 2005 and 2019 were included. Planning was MRI- and CT-based. Conventional DSA was not coregistered to the MRI and CT scans used for treatment planning and was only used as an adjunct. Obliteration dynamics and clinical outcome were analyzed.Results215 patients were included. 53.0% received SRS as first treatment; the rest underwent previous surgery, embolization, SRS, or a combination. Most AVMs were classified as Spetzler-Martin grade I to III (54.9%). Hemorrhage before treatment occurred in 46.0%. Patients suffered from headache (28.8%), and seizures (14.0%) in the majority of cases. The median SRS dose was 18 Gy and the median target volume was 2.4 cm³. New neurological deficits occurred in 5.1% after SRS, with all but one patient recovering. The yearly post-SRS hemorrhage incidence was 1.3%. In 152 patients who were followed-up for at least three years, 47.4% showed complete AVM obliteration within this period. Cox regression analysis revealed Spetzler-Martin grade (P = 0.006) to be the only independent predictor of complete obliteration.ConclusionsAlthough data on radiotherapy of AVMs is available, this is one of the largest series, focusing exclusively on CyberKnife treatment. Safety and efficacy compared favorably to frame-based systems. Non-invasive treatment planning, with a frameless SRS robotic system might provide higher patient comfort, a less invasive treatment option, and lower radiation exposure.

【 授权许可】

Unknown