Multi-staged robotic stereotactic radiosurgery for large cerebral arteriovenous malformations. 2013

Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA. Electronic address: chuxiong.ding@utsouthwestern.edu.

OBJECTIVE To investigate a multi-staged robotic stereotactic radiosurgery (SRS) delivery technique for the treatment of large cerebral arteriovenous malformations (AVMs). The treatment planning process and strategies to optimize both individual and composite dosimetry are discussed. METHODS Eleven patients with large (30.7 ± 19.2 cm(3)) AVMs were selected for this study. A fiducial system was designed for fusion of targets between planar angiograms and simulation CT scans. AVMs were contoured based on single contrast CT, MRI and orthogonal angiogram images. AVMs were divided into 3-8 sub-target volumes (3-7 cm(3)) for sequential treatment at 1-4 week intervals to a prescription dose of 16-20 Gy. Forward and inversely developed treatment plans were optimized for 95% coverage of the total AVM volume by dose summation from each sub-volume, while minimizing dose to surrounding tissues. Dose-volume analysis was used to evaluate the PTV coverage, dose conformality (CI), and R50 and V12 Gy parameters. RESULTS The treatment workflow was commissioned and able to localize within 1mm. Inverse optimization outperformed forward planning for most patients for each index considered. Dose conformality was shown comparable to staged Gamma Knife treatments. CONCLUSIONS The CyberKnife system is shown to be a practical delivery platform for multi-staged treatments of large AVMs using forward or inverse planning techniques.

UI MeSH Term Description Entries
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D011880 Radiotherapy Planning, Computer-Assisted Computer-assisted mathematical calculations of beam angles, intensities of radiation, and duration of irradiation in radiotherapy. Computer-Assisted Radiotherapy Planning,Dosimetry Calculations, Computer-Assisted,Planning, Computer-Assisted Radiotherapy,Calculation, Computer-Assisted Dosimetry,Calculations, Computer-Assisted Dosimetry,Computer Assisted Radiotherapy Planning,Computer-Assisted Dosimetry Calculation,Computer-Assisted Dosimetry Calculations,Dosimetry Calculation, Computer-Assisted,Dosimetry Calculations, Computer Assisted,Planning, Computer Assisted Radiotherapy,Radiotherapy Planning, Computer Assisted
D002538 Intracranial Arteriovenous Malformations Congenital vascular anomalies in the brain characterized by direct communication between an artery and a vein without passing through the CAPILLARIES. The locations and size of the shunts determine the symptoms including HEADACHES; SEIZURES; STROKE; INTRACRANIAL HEMORRHAGES; mass effect; and vascular steal effect. Arteriovenous Malformations, Cerebral,Intracranial Arteriovenous Malformations, Congenital,AVM (Arteriovenous Malformation) Intracranial,Cerebral Arteriovenous Malformations,Congenital Intracranial Arteriovenous Malformations,Intracranial Arteriovenous Malformation, Ruptured,Ruptured Intracranial Arteriovenous Malformation,Arteriovenous Malformation, Cerebral,Arteriovenous Malformation, Intracranial,Arteriovenous Malformations, Intracranial,Cerebral Arteriovenous Malformation,Intracranial Arteriovenous Malformation,Malformation, Cerebral Arteriovenous,Malformation, Intracranial Arteriovenous,Malformations, Cerebral Arteriovenous,Malformations, Intracranial Arteriovenous
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012371 Robotics The application of electronic, computerized control systems to mechanical devices designed to perform human functions. Formerly restricted to industry, but nowadays applied to artificial organs controlled by bionic (bioelectronic) devices, like automated insulin pumps and other prostheses. Companion Robots,Humanoid Robots,Remote Operations (Robotics),Social Robots,Socially Assistive Robots,Telerobotics,Soft Robotics,Assistive Robot, Socially,Companion Robot,Humanoid Robot,Operation, Remote (Robotics),Operations, Remote (Robotics),Remote Operation (Robotics),Robot, Companion,Robot, Humanoid,Robot, Social,Robot, Socially Assistive,Robotic, Soft,Social Robot,Socially Assistive Robot,Soft Robotic
D016634 Radiosurgery A radiological stereotactic technique developed for cutting or destroying tissue by high doses of radiation in place of surgical incisions. It was originally developed for neurosurgery on structures in the brain and its use gradually spread to radiation surgery on extracranial structures as well. The usual rigid needles or probes of stereotactic surgery are replaced with beams of ionizing radiation directed toward a target so as to achieve local tissue destruction. Gamma Knife Radiosurgery,Linear Accelerator Radiosurgery,Stereotactic Body Radiotherapy,Stereotactic Radiosurgery,CyberKnife Radiosurgery,LINAC Radiosurgery,Radiosurgery, Gamma Knife,Radiosurgery, Linear Accelerator,Radiosurgery, Stereotactic,Stereotactic Radiation,Stereotactic Radiation Therapy,CyberKnife Radiosurgeries,Gamma Knife Radiosurgeries,LINAC Radiosurgeries,Linear Accelerator Radiosurgeries,Radiation Therapy, Stereotactic,Radiation, Stereotactic,Radiosurgery, CyberKnife,Radiosurgery, LINAC,Radiotherapy, Stereotactic Body,Stereotactic Body Radiotherapies,Stereotactic Radiation Therapies,Stereotactic Radiations,Stereotactic Radiosurgeries,Therapy, Stereotactic Radiation
D021621 Imaging, Three-Dimensional The process of generating three-dimensional images by electronic, photographic, or other methods. For example, three-dimensional images can be generated by assembling multiple tomographic images with the aid of a computer, while photographic 3-D images (HOLOGRAPHY) can be made by exposing film to the interference pattern created when two laser light sources shine on an object. Computer-Assisted Three-Dimensional Imaging,Imaging, Three-Dimensional, Computer Assisted,3-D Image,3-D Imaging,Computer-Generated 3D Imaging,Three-Dimensional Image,Three-Dimensional Imaging, Computer Generated,3 D Image,3 D Imaging,3-D Images,3-D Imagings,3D Imaging, Computer-Generated,3D Imagings, Computer-Generated,Computer Assisted Three Dimensional Imaging,Computer Generated 3D Imaging,Computer-Assisted Three-Dimensional Imagings,Computer-Generated 3D Imagings,Image, 3-D,Image, Three-Dimensional,Images, 3-D,Images, Three-Dimensional,Imaging, 3-D,Imaging, Computer-Assisted Three-Dimensional,Imaging, Computer-Generated 3D,Imaging, Three Dimensional,Imagings, 3-D,Imagings, Computer-Assisted Three-Dimensional,Imagings, Computer-Generated 3D,Imagings, Three-Dimensional,Three Dimensional Image,Three Dimensional Imaging, Computer Generated,Three-Dimensional Images,Three-Dimensional Imaging,Three-Dimensional Imaging, Computer-Assisted,Three-Dimensional Imagings,Three-Dimensional Imagings, Computer-Assisted

Related Publications

Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
September 2017, Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
January 2011, Stereotactic and functional neurosurgery,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
January 2016, PloS one,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
August 2025, Neurosurgery,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
September 2012, Neurosurgery,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
July 2022, Neurosurgical focus,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
May 2002, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
January 2018, Journal of neurosurgery,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
December 2008, Journal of neurosurgery,
Chuxiong Ding, and Timothy D Solberg, and Brian Hrycushko, and Paul Medin, and Louis Whitworth, and Robert D Timmerman
February 2009, Acta neurochirurgica,
Copied contents to your clipboard!