Scarbrough TJ, Crocker IR, Davis LW, Barrow DL, Fowler BZ, Oyesiku NM. Intracranial arteriovenous malformations treated utilizing a linear accelerator-based patient rotator or commercially available radiosurgery system.
Stereotact Funct Neurosurg 2005;
83:91-100. [PMID:
16037682 DOI:
10.1159/000087125]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE
To report a single-institution experience with intracranial arteriovenous malformations (AVMs) treated utilizing a linear accelerator-based patient rotator (PR) or BrainLAB (BL) radiosurgery system (BrainLAB AG, Heimstetten, Germany).
METHODS AND MATERIALS
Since 1989, 84 evaluable patients were treated. PR patients (n = 45) were planned/localized on the basis of biplane angiography and treated between 1989 and 2000. BL patients (n = 39) were planned/localized on the basis of CT/MRI and treated since 2000. Kaplan-Meier analyses of survival, nidus obliteration (NO), and any radiographic improvement were undertaken with Cox regression of dose and volume effects.
RESULTS
No significant complication, survival, previous embolization incidence, AVM location or size differences existed between BL/PR patients. The groups differed significantly in prescribed dose (PR: 16.2 Gy, BL: 17.3 Gy, p = 0.004) and isodose (PR: 62%, BL: 79%, p < 0.0001). Estimated 2-year NO rate was 87% for BL patients, 12% for PR patients (p < 0.0001). Ultimate PR NO rate was 67% at 6 years. Dose (p = 0.037) and isodose (p = 0.014) significantly affected PR NO outcome; volume was of borderline significance (p = 0.069). No factors significantly affected BL outcome. Analyses of small (< or = 4.0 cm3), high-dose (> or = 17.0 Gy) PR patients (PR1 group) vs. BL patients still demonstrated greater NO (p = 0.04) and radiographic improvement (p = 0.0004) rates for the BL group. PR1 patients had a 76% 3-year NO rate.
CONCLUSIONS
BL-based radiosurgery achieved a high NO rate, the PR method did not. Differences in outcomes between PR/BL groups may be due to localization methods or an inherent advantage with the BL system.
Collapse