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Completion of Gamma Knife radiosurgery for AVM treatment after unplanned interruption—technical note

  • Technical Note - Neurosurgical Techniques
  • Published:
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Abstract

Background and importance

Gamma 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 presentation

In 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.

Conclusion

Our 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.

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Authors and Affiliations

  1. Department of Neurological Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8057, St. Louis, MO, 63110, USA

    Hari S. Raman, Ananth K. Vellimana & Gregory J. Zipfel

  2. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA

    Lakshmi Santanam, Robert E. Drzymala & Christina I. Tsien

Authors
  1. Hari S. Raman
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  2. Lakshmi Santanam
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  3. Ananth K. Vellimana
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  4. Robert E. Drzymala
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  5. Christina I. Tsien
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  6. Gregory J. Zipfel
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Corresponding author

Correspondence to Gregory J. Zipfel.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written consent was obtained from the patient for publication of their treatment course.

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Raman, H.S., Santanam, L., Vellimana, A.K. et al. Completion of Gamma Knife radiosurgery for AVM treatment after unplanned interruption—technical note. Acta Neurochir 160, 1343–1347 (2018). https://doi.org/10.1007/s00701-018-3493-0

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  • DOI: https://doi.org/10.1007/s00701-018-3493-0

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