gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

LINAC-radiosurgery for arteriovenous malformations of the brain stem and thalamus

LINAC-Radiochirurgie zur Behandlung von arteriovenösen Malformationen in Hirnstamm und Thalamus

Meeting Abstract

  • corresponding author Lars Wojtecki - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln, Köln
  • M. Maarouf - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln, Köln
  • J. Voges - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln, Köln
  • M. Zähringer - Institut für Radiologische Diagnostik, Universitätsklinikum Köln, Köln
  • M. Kocher - Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Köln, Köln
  • H. Treuer - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln, Köln
  • V. Sturm - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln, Köln

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.03.09

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0266.shtml

Published: April 23, 2004

© 2004 Wojtecki et al.
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Outline

Text

Objective

The presented retrospective analysis was addressed to the efficiency of LINAC-radiosurgery (LINAC-RS) in arteriovenous malformations (AVMs) of highly-eloquent deep brain areas like the brains stem, thalamus or basal ganglia with regard to radiation dose, Spetzler/Martin grading and diameter of the nidus.

Methods

53/95 patients treated from 11/90 to 5/03 with a follow-up of ≥18 months were analysed retrospectively. A median single dose of 20 Gy (range: 9-25 Gy) was applied to the surface of the AVM nidus, which was delineated on stereotactic angiograms. Isocenters. Width of the collimators and dose distribution were calculated and controlled 3-dimensionally on stereotactic tomographic images (stereotactic CT and MRI). Regular follow-up investigations included assessment of the neurological status as well as MRI and angiographic examinations.

Results

The malformations were graded according to Spetzler/Martin (Grade II: n=2, Grade III: n=36, Grade IV: n=13). Follow-up angiography documented obliteration in n=32/41 patients (78%) and partial obliteration or persisting venous drainage in n=9/41 patients. Obliteration was correlated with high radiation dose (≤15 Gy: n=7/11, 63.3%; >15 Gy: n=25/30, 83.3%) low Spetzler/Martin grading (Grade II-III: n=28/31, 90.3%; Grade IV: n=3/9, 33.3%) and small diameter of the nidus (≤30 mm: n=25/27, 92.6%; > 30mm: n=3/10, 30%).

Conclusions

LINAC-RS with doses >15 Gy is highly effective for the treatment of AVM in highly-eloquent areas like the brain stem, thalamus or basal ganglia with Spetzler/ Martin-Grades <IV or diameters <30 mm. In large AVMs LINAC-RS with moderate doses yields obliteration rates of about 30%.