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Radiosurgery for Arteriovenous Malformations: the University of Toronto Experience

Published online by Cambridge University Press:  18 September 2015

C. Young ,
R. Summerfield ,
M. Schwartz ,
P. O'Brien  and
R. Ramani
C. Young*
Affiliation:
Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Science Centre, University of Toronto Brain Vascular Malformation Study Group
R. Summerfield
Affiliation:
Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Science Centre, University of Toronto Brain Vascular Malformation Study Group
M. Schwartz
Affiliation:
Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Science Centre, University of Toronto Brain Vascular Malformation Study Group
P. O'Brien
Affiliation:
Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Science Centre, University of Toronto Brain Vascular Malformation Study Group
R. Ramani
Affiliation:
Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook Health Science Centre, University of Toronto Brain Vascular Malformation Study Group
*
Toronto-Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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Abstract:

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Background:

From July 1989 to February 1996, 130 patients underwent sterotactic radiosurgery. We report the results of the first 50 patients eligible for a minimum of three years of follow-up.

Methods:

Twenty women and 30 men, (mean age: 37.5 years) were treated by dynamic rotation on a 6 MV linear accelerator. Prior treatment was embolization in seventeen, surgery in three and embolization and surgery in six. All had DSA and enhanced CT scanning, while some had MRI. Forty-seven treatments used a single isodose. Restricting eloquent normal tissue to 15 Gy, margin doses (at 50 - 90% isodose) were 12 Gy (one patient); 15 Gy (sixteen patients); 20 Gy (31 patients); 25 Gy (two patients). Maximum diameters were: <1.5 cm (12 patients); < 2.0 cm (nine patients); < 2.5 cm (twelve patients); < 3.0 cm (thirteen patients; 3.0 cm (four patients).

Results:

Forty-five patients were evaluable at three years, with thirty-nine having angiography. Twenty-five had angiographically confirmed obliterations; two had parenchymal AVMs obliterated but with residual dural components; four had MRI evidence of obliteration (refused angiography). One patient acutely had a seizure; one patient (with hemorrhages, resection, and embolizations preceding two applications of radiosurgery, separated by 3.5 years) had worsening of memory.

Conclusions:

Our uncorrected (five patients unevaluable at three years) and corrected angiographically confirmed obliteration rates are 54% and 60% respectively. Our follow-up (98% accounting of cohort; 78% angiographic rate) and explicit derivation of denominators help delineate the efficacy of radiosurgery at these doses.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 2 , May 1997 , pp. 99 - 105
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

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