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Fractionated, stereotactic proton beam treatment of cerebral arteriovenous malformations
Author(s) -
Silander H.,
Pellettieri L.,
Enblad P.,
Montelius A.,
Grusell E.,
VallhagenDahlgren C.,
Isacsson U.,
Nyberg G.,
Moström U.,
Lilja A.,
Gál G.,
Blomquist E.
Publication year - 2004
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1046/j.1600-0404.2003.00154.x
Subject(s) - medicine , nuclear medicine , arteriovenous malformation , intracranial arteriovenous malformations , adverse effect , magnetic resonance imaging , radiology , angiography , cerebral angiography
Objectives – To evaluate the therapeutic efficiency and adverse effects of stereotactic proton beam treatment of cerebral arteriovenous malformations (AVM). Material and methods – Twenty‐six patients treated in Uppsala during 1991–97 were included (men = 14, women = 12; mean age = 39, range = 23–64). The nidus volumes ranged from 0.3 to 102 ml (mean = 24, median = 13). The follow‐up included clinical evaluation, magnetic resonance imaging (and/or computed tomography) every 6–12 months for 3 years and final angiography. Results – The volume changes at final follow‐up in AVMs >25 ml were −89, −85, −44, −29, −7, 0, 0, +5 and +18 (%); in AVMs 11–24 ml, −100, −100, −97, −92 and 0 (%); and in AVMs <10 ml, −100, −100, −100, −100, −100, −99, −98, −50, −0 and +40 (%). Two patients were lost to follow‐up due to cerebral haemorrhage and myocardial infarction. Radiology displayed significant perifocal oedema in one patient and slight oedema in four patients. Of nine patients with epilepsy, seven became seizure‐free after therapy while two continued to suffer from seizures. Conclusion – Proton beam irradiation is successful in a relatively high proportion of intermediate and large‐sized cerebral AVMs. The adverse effects are acceptable. The advantage of proton treatment compared with gamma knife and LINAC stereotactic irradiation is that protons can irradiate even large volumes with a very sharp dose profile against normal surroundings. Thus, proton beam irradiation is a valuable option in the treatment of AVMs larger than 10 ml.