Article
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
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Published: | May 30, 2008 |
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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.