gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Radiosurgery using computer-based micro-multi-leaf-collimator for large cerebral arteriovenous malformations

Micro-Multi-Leaf-Collimator LINAC-Radiochirurgie zur Behandlung von großen zerebralen arteriovenösen Malformationen

Meeting Abstract

  • corresponding author M. Maarouf - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln
  • C. Kühn - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln
  • J. Voges - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln
  • M. Hoevels - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln
  • R.-P. Müller - Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Köln
  • K. Lackner - Institut und Poliklinik für Radiologie, Universitätsklinikum Düsseldorf
  • V. Sturm - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.02.07

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc157.shtml

Published: May 30, 2008

© 2008 Maarouf et al.
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Outline

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Objective: To determine the efficacy and safety of LINAC radiosurgery using the micro-multi-leaf-collimator (µMLC-RS) in the treatment of large cerebral AVMs.

Methods: From February 2001 through December 2005, 37 patients (F:M =19:18, age 12–68 years, median 39 years) with large cerebral AVMs (volume ≥10 cm3 or diameter >30 mm) were treated with stereotactic µMLC-RS according to a prospective protocol. Prior to radiosurgery, 16/37 (43%) patients experienced intracranial hemorrhage, 6/37 (16.2%) seizure, 10/39 (26%) progressive neurological deficits and 5/37 cephalgia. Eleven of 37 patients (29.7%) were treated by endovascular embolization before radiosurgery. The median volume and diameter of the AVM-Nidus was 10.5±11.5 cm3 and 38±9 mm (range, 3.01–6.4 mm), respectively. A median therapeutic dose of 13 Gy (range, 9–20 Gy) was applied to the surface of the nidus.

Results: Four of 37 (10,8%) patients developed new or progressive neurological deficits after a median clinical follow-up of 28±13,3 months (range, 2.5–56.4). Non of the deficits was permanent. One patient experienced a hemorrhage post radiosurgery. Twenty of 37 patients had a sufficient radiological follow-up. Fifteen of 20 patients (75%) revealed an AVM obliteration on neuroradiological follow-up (DSA/MRI).

Conclusions: Our preliminary results show that stereotactic LINAC-radiosurgery using the computerized micro-multi-leaf-collimator for the treatment of large cerebral AVMs is effective with a favorable occlusion rate. There was no permanent treatment associated morbidity and mortality.