OBJECTIVE: CyberKnife 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. METHODS: In 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. RESULTS: 215 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. CONCLUSIONS: Although 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.
OBJECTIVE: CyberKnife 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. METHODS: In 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. RESULTS: 215 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. CONCLUSIONS: Although 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.
Authors: Hideyuki Kano; L Dade Lunsford; John C Flickinger; Huai-che Yang; Thomas J Flannery; Nasir R Awan; Ajay Niranjan; Josef Novotny; Douglas Kondziolka Journal: J Neurosurg Date: 2011-11-11 Impact factor: 5.115
Authors: Xing-Qi Lu; Anand Mahadevan; George Mathiowitz; Pei-Jan P Lin; Ajith Thomas; Ekkehard M Kasper; Scott R Floyd; Edward Holupka; Salvatore La Rosa; Frank Wang; Mary Ann Stevenson Journal: Int J Radiat Oncol Biol Phys Date: 2012-01-26 Impact factor: 7.038
Authors: Dimitre Hristov; Lina Liu; John R Adler; Iris C Gibbs; Teri Moore; Marily Sarmiento; Steve D Chang; Robert Dodd; Michael Marks; Huy M Do Journal: Int J Radiat Oncol Biol Phys Date: 2011-03-15 Impact factor: 7.038
Authors: H U Kauczor; R Engenhart; G Layer; A H Gamroth; B Wowra; L R Schad; W Semmler; G van Kaick Journal: J Comput Assist Tomogr Date: 1993 Mar-Apr Impact factor: 1.826
Authors: Xin Wang; Enmin Wang; Guanghai Mei; Xiaoxia Liu; Huaguang Zhu; Li Pan; Jiazhong Dai; Yang Wang Journal: Zhonghua Yi Xue Za Zhi Date: 2014-10-14
Authors: J P Mohr; Michael K Parides; Christian Stapf; Ellen Moquete; Claudia S Moy; Jessica R Overbey; Rustam Al-Shahi Salman; Eric Vicaut; William L Young; Emmanuel Houdart; Charlotte Cordonnier; Marco A Stefani; Andreas Hartmann; Rüdiger von Kummer; Alessandra Biondi; Joachim Berkefeld; Catharina J M Klijn; Kirsty Harkness; Richard Libman; Xavier Barreau; Alan J Moskowitz Journal: Lancet Date: 2013-11-20 Impact factor: 79.321