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J Clin Neurosci. 2016 Jul;29:162-7. doi: 10.1016/j.jocn.2015.12.005. Epub 2016 Feb 8.

Stereotactic radiosurgery for intramedullary spinal arteriovenous malformations.

Author information

1
Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA.
2
Department of Neurosurgery, University of California, San Francisco, CA, USA.
3
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
4
Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Room R-225, Stanford, CA 94305, USA. Electronic address: sdchang@stanford.edu.

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.

KEYWORDS:

CyberKnife; Glomus AVM; Intramedullary; Spinal arteriovenous malformation; Stereotactic radiosurgery

PMID:
26869363
DOI:
10.1016/j.jocn.2015.12.005
[Indexed for MEDLINE]

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