Completion of Gamma Knife radiosurgery for AVM treatment after unplanned interruption-technical note.
Completion of Gamma Knife radiosurgery for AVM treatment after unplanned interruption-technical note.
复制标题
意外中断后完成伽玛刀放射外科治疗 AVM 技术说明。
DOI：
10.1007/s00701-018-3493-0
复制
发表时间：
2018
影响因子：
2.4
通讯作者：
Zipfel,GregoryJ
中科院分区：
文献类型：
--
作者：
Raman,HariS;Santanam,Lakshmi;Vellimana,AnanthK;Drzymala,RobertE;Tsien,ChristinaI;Zipfel,GregoryJ
背景和重要性伽玛刀放射外科是一种成熟的技术，用于各种颅内病变的非紧急治疗。内程序移位的立体定向框架是一种罕见的情况下，可能会导致流产正在进行的治疗，并需要更多的侵入性treatment strategies.Clinical presentationIn this case report，我们描述了一种新的方法恢复伽玛刀治疗后，计划外的程序中断。案例的例子涉及放射外科治疗的Spetzler-Martin I级动静脉畸形。ConclusionOur技术涉及整合的扫描和坐标系统从两个成像会话使用的复合等剂量线，以解决平移的差异，从而限制剩余的镜头的未处理区域的病变。13个月时的MRI随访显示病灶大小减小，没有证据表明周围脑实质有任何放射损伤。我们相信这项技术将使护理团队能够有效地挽救中断的伽玛刀手术，并减少进展到更具侵入性的治疗方案。
Background and importanceGamma Knife radiosurgery is an established technique for non-urgent treatment of various intracranial pathologies. Intra-procedural dislodgement of the stereotactic frame is an uncommon occurrence that could lead to abortion of ongoing treatment and necessitate more invasive treatment strategies.Clinical presentationIn this case report, we describe a novel method for resumption of Gamma Knife treatment after an unplanned intra-procedural interruption. The case example involves a radiosurgical treatment of a Spetzler-Martin grade I arteriovenous malformation.ConclusionOur technique involves integration of scans and coordinate systems from two imaging sessions using the composite isodose line to resolve translational differences, thereby limiting delivery of remaining shots to the untreated region of the lesion. MRI follow-up at 13 months showed a reduction in the nidus size with no evidence of any radiation injury to the surrounding brain parenchyma. We believe this technique will allow care teams to effectively salvage interrupted Gamma Knife procedures and reduce progression to more invasive treatment options.