Integration of corticospinal tractography reduces motor complications after radiosurgery.
OBJECTIVE
To evaluate whether the use of diffusion-tensor tractography (DTT) of the corticospinal tract could reduce motor complications after stereotactic radiosurgery (SRS).


METHODS
Patients with arteriovenous malformation (AVM) in the deep frontal lobe, deep parietal lobe, basal ganglia, and thalamus who had undergone radiosurgery since 2000 and were followed up for more than 3 years were studied. DTT of the corticospinal tract had been integrated into treatment planning of SRS since 2004, and the maximum dose received by the corticospinal tract was attempted to be less than 20 Gy. Treatment outcomes before (28 patients, Group A) and after (24 patients, Group B) the introduction of this technique were compared.


RESULTS
There were no statistical differences between the two groups (Group A vs. Group B) in patients' age (34 years vs. 33 years, p = 0.76), percentage of patients with hemorrhagic events before treatment (50% vs. 29%, p = 0.12), or percentage of AVM involving the basal ganglia and thalamus (36% vs. 46%, p = 0.46). Obliteration rates were 69% and 76% at 4 years in Groups A and B, respectively (p = 0.68), which were not significantly different. Motor complications were observed in 5 patients in Group A (17.9%) but only in 1 patient in Group B (4.2%), which was significantly less frequent (p = 0.021).


CONCLUSIONS
Integrating DTT of the corticospinal tract into treatment planning contributed to reduction of motor complications without compromising the obliteration rate for AVM adjacent to the corticospinal tract.
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan. kouga-tky@umin.ac.jp
Tomoyuki
T
Koga
Masahiro
M
Shin
Keisuke
K
Maruyama
Kyousuke
K
Kamada
Takahiro
T
Ota
Daisuke
D
Itoh
Naoto
N
Kunii
Kenji
K
Ino
Shigeki
S
Aoki
Yoshitaka
Y
Masutani
Hiroshi
H
Igaki
Tsuyoshi
T
Onoe
Nobuhito
N
Saito
D000293:Adolescent; D000328:Adult; D001039:Aphasia, Broca / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D056324:Diffusion Tensor Imaging / Q000379:methods*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D011712:Pyramidal Tracts / Q000528:radiation effects*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D055815:Young Adult