title: Stereotactic helium ion Bragg peak radiosurgery for intracranial arteriovenous malformations. Detailed clinical and neuroradiologic outcome.
abstract: 89 patients with angiographically documented arteriovenous malformations were treated with helium ion Bragg peak radiation. The rate of complete angiographic obliteration 2 years after radiation was 94% in those lesions smaller than 4 cm3 (2.0 cm in diameter), 75% for those 4-25 cm3 and 39% for those larger than 25 cm3 (3.7 cm in diameter); at 3 years after radiation, the corresponding obliteration rates were 100, 95 and 70%. Major clinical complications occurred in 10 patients (8 permanent, 2 transient) between 3 and 21 months after treatment; all were in the initial stage of the protocol (higher radiation doses). 10 patients bled from residual malformation between 4 and 34 months after treatment. Seizures were improved in 63% and headaches in 68% of patients. Excellent or good clinical outcome was achieved in 94% of patients. Compared to the natural history and risks of surgery for these difficult malformations, we consider these results encouraging. Heavy-charged-particle radiation is a valuable therapy for surgically inaccessible symptomatic cerebral arteriovenous malformations. The current procedure has two disadvantages: the prolonged latent period before complete obliteration and the small risk of serious neurological complications.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Calif.
authors.forename: G K
authors.initials: GK
authors.lastname: Steinberg
authors.forename: J I
authors.initials: JI
authors.lastname: Fabrikant
authors.forename: M P
authors.initials: MP
authors.lastname: Marks
authors.forename: R P
authors.initials: RP
authors.lastname: Levy
authors.forename: K A
authors.initials: KA
authors.lastname: Frankel
authors.forename: M H
authors.initials: MH
authors.lastname: Phillips
authors.forename: L M
authors.initials: LM
authors.lastname: Shuer
authors.forename: G D
authors.initials: GD
authors.lastname: Silverberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D005260:Female; D006371:Helium; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery*; D007477:Ions; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016634:Radiosurgery / Q000009:adverse effects; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed
chemical_list: D007477:Ions; D006371:Helium