Steven D. Chang, MD, the Robert C. and Jeannette Powell Professor

Publication Details

• Cyberknife radiosurgery for arteriovenous malformations

  Chang SD, Adler JR. Rivista Medica. 2007; 13 (1): 71-77

  Intro: Radiosurgery is a well accepted treatment for AVMs of the central nervous system. We present our experience at Stanford University in treating brain and spinal cord AVMs with the CyberKnife. Methods: 48 patients with brain AVMs and 15 patients with spinal cord AVMs were treated over the last 6 years at Stanford University (Stanford, CA) with the Cyberknife. Patients were followed both with radiologic exams and clinical evaluation every 6 months. Follow-up angiography was performed at 3 years post treatment. In some cases of spinal cord AVMs or large brain AVMs, staged radiosurgery or multisession radiosurgery was performed. Results: For brain AVMs, 32 patients had both greater than three years follow-up and had undergone follow-up angiographic imaging. Twenty five of these 32 patients demonstrated AVM obliteration for a 78% obliteration rate. Four patients developed posttreatment radiation edema. For spinal AVMs, after a mean follow-up period of 34 months (range, 9 to 65 months) eight patients were more than three years from radiosurgery. Spinal angiography showed complete obliteration of three of the AVMs. Of the remaining five patients, four patients showed significant reduction in AVM volume on either MR imaging or spinal angiography. Two patients developed transient radiation-induced edema with in the spinal cord. Conclusion: CyberKnife radiosurgery offers an effective treatment for AVMs of the brain and spinal cord.