title: CyberKnife stereotactic radiosurgery for the treatment of symptomatic vertebral hemangiomas: a single-institution experience.
abstract: OBJECTIVE Symptomatic vertebral hemangiomas (SVHs) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given the relative rarity and difficulty in assessment, the authors sought to present a dedicated series of SVHs treated using stereotactic radiosurgery (SRS) to provide insight into clinical decision making. METHODS A retrospective review of a single institution's experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. The authors report and analyze the treatment course of 5 patients with 7 lesions, 2 of which were treated primarily by SRS. RESULTS Of the 5 patients studied, 4 presented with a chief complaint of pain refractory to conservative measures. Three patients reported dysesthesias, and 2 reported upper-extremity weakness. Following radiosurgery, 4 of 5 patients exhibited improvement in their primary symptoms (3 for pain and 1 for weakness), achieving a clinical response after a mean period of 1 year. In 2 cases there was 20%-40% reduction in lesion size in the most responsive dimension as noted on images. All treatments were well tolerated. CONCLUSIONS SRS for SVH is a safe and feasible treatment strategy, comparable to prior radiotherapy studies, and in select cases may successfully confer delayed decompressive effects. Additional investigation will determine future patient selection and how conformal SRS treatment can best be administered.
authors.affiliation: Department of Neurosurgery, Stanford University, Palo Alto, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Stanford University, Palo Alto, California.
authors.forename: Yi-Ren
authors.initials: YR
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Stanford University, Palo Alto, California.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Stanford University, Palo Alto, California.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: BED = biologically effective dose; CyberKnife; SRS = stereotactic radiosurgery; SVH = symptomatic vertebral hemangioma; hypofractionation; nBED = normalized BED; spine; stereotactic radiosurgery; symptomatic vertebral hemangioma