Artikel
Magnetic resonance imaging-based robotic radiosurgery of arteriovenous malformations
Magnetresonanztomographie-basierte radiochirurgische Behandlung arteriovenöser Malformationen
Suche in Medline nach
Autoren
Veröffentlicht: | 4. Juni 2021 |
---|
Gliederung
Text
Objective: CyberKnife offers purely 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.
Methods: In this retrospective study, 270 patients with cerebral AVMs treated by CyberKnife SRS between 2005 and 2019 were screened for inclusion. Patients below 18 years of age, or with follow-up periods < 3 months were excluded. Radiosurgical planning was purely MRI- and CT-based. Obliteration dynamics and clinical outcome were analyzed.
Results: 215 patients were included (median age 40 ± 13 years, 49% female). 53% received SRS as first treatment; the remainder had prior surgery, embolization, SRS, or a combination. The majority of AVMs were classified as Spetzler-Martin grade I to III (55%). Hemorrhage before treatment occurred in 46%. The median radiation dose was 18 Gy and the median target volume was 2.4 cm³. The most prevalent presenting symptom was headache (29%). New neurological deficits after SRS occurred in 5%. After SRS, 29 patients (14%) developed new seizures. Of all 59 (28%) patients manifesting symptomatic epilepsy before or after SRS, 36 were adequately controlled with medication. The yearly post-SRS hemorrhage incidence was 1.3%. In 152 patients who were followed-up for three years, 47% showed complete obliteration within this period. In univariate analysis, previous surgery (P = 0.028) and Spetzler-Martin grade (P = 0.007) were associated with increased chance of complete obliteration. Spetzler-Martin remained the only independent predictor of complete obliteration (P = 0.006) in multivariate analysis.
Conclusion: The obliteration rate in this cohort is consistent with data on Gamma Knife and LINAC-based SRS, where obliteration rates ranged between 30% and 58%. The rate of new neurological deficits in our cohort (5%) was comparable to a large meta-analysis on SRS treatment of cerebral AVMs with 8%.
Although data on radiosurgery of AVMs is available, this is one of the largest series, focusing exclusively on CyberKnife treatment. We showed that the frameless CyberKnife system compares favorably to frame-based systems in terms of safety and efficacy while providing higher patient comfort during treatment.