Use of cone-beam computed tomography angiography in planning for gamma knife radiosurgery for arteriovenous malformations: a case series and early report.

摘要: BACKGROUND The effectiveness of Gamma Knife radiosurgery (GKR) for cerebral arteriovenous malformations (AVMs) is predicated on inclusion the entire nidus while excluding normal tissue. As such, GKR may be limited by resolution and accuracy imaging modality used in targeting. OBJECTIVE We present first case series to demonstrate feasibility using ultrahigh-resolution C-arm cone-beam computed tomography angiography (CBCT-A) AVM METHODS From June 2009 2013, CBCT-A was targeting all patients with AVMs treated at our institution. Patients underwent Leksell stereotactic head frame placement followed catheter-based biplane 2-dimensional digital subtraction angiography, 3-dimensional rotational as well CBCT-A. dataset planning GKR. were 1, 3, 6, 12 months then annually thereafter. RESULTS CBCT-A-based 22 consecutive patients. provided detailed spatial sensitivity nidal angioarchitecture enabling treatment. average radiation dose margin corresponding 50% isodose line 15.6 Gy. No patient had treatment-associated hemorrhage. At early follow-up (mean, 16 months), 84% a decreasing or obliterated nidus. CONCLUSION CBCT-A-guided feasible useful because it provides sufficient brain AVMs.