title: Stereotactic radiosurgery for intramedullary spinal arteriovenous malformations.
abstract: Spinal cord arteriovenous malformations (AVM) are rare lesions associated with recurrent hemorrhage and progressive ischemia. Occasionally a favorable location, size or vascular anatomy may allow management with endovascular embolization and/or microsurgical resection. For most, however, there is no good treatment option. Between 1997 and 2014, we treated 37 patients (19 females, 18 males, median age 30years) at our institution diagnosed with intramedullary spinal cord AVM (19 cervical, 12 thoracic, and six conus medullaris) with CyberKnife (Accuray, Sunnyvale, CA, USA) stereotactic radiosurgery. A history of hemorrhage was present in 50% of patients. The mean AVM volume of 2.3cc was treated with a mean marginal dose of 20.5Gy in a median of two sessions. Clinical and MRI follow-up were carried out annually, and spinal angiography was repeated at 3years. We report an overall obliteration rate of 19% without any post-treatment hemorrhagic events. In those AVM that did not undergo obliteration, significant volume reduction was noted at 3years. Although the treatment paradigm for spinal cord AVM continues to evolve, radiosurgical treatment is capable of safely obliterating or significantly shrinking most intramedullary spinal cord AVM.
authors: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA.
authors: Maziyar A
authors: MA
authors: Kalani
authors: Department of Neurosurgery, University of California, San Francisco, CA, USA.
authors: Omar
authors: O
authors: Choudhri
authors: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Iris C
authors: IC
authors: Gibbs
authors: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Scott G
authors: SG
authors: Soltys
authors: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA.
authors: John R
authors: JR
authors: Adler
authors: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA.
authors: Patricia A
authors: PA
authors: Thompson
authors: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA.
authors: Armine T
authors: AT
authors: Tayag
authors: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA.
authors: Cindy H
authors: CH
authors: Samos
authors: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA. Electronic address: sdchang@stanford.edu.
authors: Steven D
authors: SD
authors: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery*; D016896:Treatment Outcome
keywords: CyberKnife; Glomus AVM; Intramedullary; Spinal arteriovenous malformation; Stereotactic radiosurgery