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CyberKnife radiosurgery for spinal intramedullary arteriovenous malformations: a single-center experience.
World Neurosurg. 2023 Mar 18 [Online ahead of print]WN

Abstract

BACKGROUND

Intramedullary spinal AVM (ISAVM, glomus type) is a type of spinal cord arteriovenous malformation, which is a rare disease known often to have a complex vascular supply interfering with that of the spinal cord, and is in complex anatomical relations with cord structures and nerve roots. Though microsurgical and endovascular treatment has mainly been the standard options, in high-risk cases with these treatments, stereotactic radiotherapy (SRT) might be the option of choice.

METHOD

We retrospectively reviewed 10 consecutive patients with ISAVM who received SRT using CyberKnife® (Accuray, Inc., Sunnyvale, CA) at the Japanese Red Cross Medical Center (Tokyo, Japan) from 2011/1-2022/3.

RESULTS

No case in this series suffered from hemorrhage after applying SRT. One case experienced neurological impairment ten years after SRT, which we attributed to venous congestion due to the remaining lesion. No case of radiation myelopathy was observed in this series. In one case, the nidus volume reduction and loss of flow voids were obvious, though improvement in the neurological outcome was not apparent. No radiological changes were observed in the other nine patients.

CONCLUSION

Even in lesions without radiological changes, no hemorrhagic events were observed for an average period of 4 years. SRT may be a feasible option in treating ISAVM, especially for lesions in which microsurgical resection and endovascular treatment are inapplicable. To ascertain the safety and efficacy of this approach, further studies with more patients and longer follow up is required.

Authors+Show Affiliations

Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: meatballnikudanngo@gmail.com.Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.Kamiyacho Neurosurgical Clinic, Tokyo, Japan.Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36940806

Citation

Suzuki, Tomoya, et al. "CyberKnife Radiosurgery for Spinal Intramedullary Arteriovenous Malformations: a Single-center Experience." World Neurosurgery, 2023.
Suzuki T, Kagawa K, Sato K, et al. CyberKnife radiosurgery for spinal intramedullary arteriovenous malformations: a single-center experience. World Neurosurg. 2023.
Suzuki, T., Kagawa, K., Sato, K., Nomura, R., Irie, K., & Ichi, S. (2023). CyberKnife radiosurgery for spinal intramedullary arteriovenous malformations: a single-center experience. World Neurosurgery. https://doi.org/10.1016/j.wneu.2023.03.058
Suzuki T, et al. CyberKnife Radiosurgery for Spinal Intramedullary Arteriovenous Malformations: a Single-center Experience. World Neurosurg. 2023 Mar 18; PubMed PMID: 36940806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CyberKnife radiosurgery for spinal intramedullary arteriovenous malformations: a single-center experience. AU - Suzuki,Tomoya, AU - Kagawa,Kenji, AU - Sato,Kengo, AU - Nomura,Ryutaro, AU - Irie,Koreaki, AU - Ichi,Shunsuke, Y1 - 2023/03/18/ PY - 2023/01/26/received PY - 2023/03/13/revised PY - 2023/03/14/accepted PY - 2023/3/20/entrez PY - 2023/3/21/pubmed PY - 2023/3/21/medline KW - CyberKnife KW - spinal arteriovenous malformations KW - stereotactic radiotherapy JF - World neurosurgery JO - World Neurosurg N2 - BACKGROUND: Intramedullary spinal AVM (ISAVM, glomus type) is a type of spinal cord arteriovenous malformation, which is a rare disease known often to have a complex vascular supply interfering with that of the spinal cord, and is in complex anatomical relations with cord structures and nerve roots. Though microsurgical and endovascular treatment has mainly been the standard options, in high-risk cases with these treatments, stereotactic radiotherapy (SRT) might be the option of choice. METHOD: We retrospectively reviewed 10 consecutive patients with ISAVM who received SRT using CyberKnife® (Accuray, Inc., Sunnyvale, CA) at the Japanese Red Cross Medical Center (Tokyo, Japan) from 2011/1-2022/3. RESULTS: No case in this series suffered from hemorrhage after applying SRT. One case experienced neurological impairment ten years after SRT, which we attributed to venous congestion due to the remaining lesion. No case of radiation myelopathy was observed in this series. In one case, the nidus volume reduction and loss of flow voids were obvious, though improvement in the neurological outcome was not apparent. No radiological changes were observed in the other nine patients. CONCLUSION: Even in lesions without radiological changes, no hemorrhagic events were observed for an average period of 4 years. SRT may be a feasible option in treating ISAVM, especially for lesions in which microsurgical resection and endovascular treatment are inapplicable. To ascertain the safety and efficacy of this approach, further studies with more patients and longer follow up is required. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/36940806/CyberKnife_radiosurgery_for_spinal_intramedullary_arteriovenous_malformations:_a_single_center_experience_ DB - PRIME DP - Unbound Medicine ER -
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