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Neurosurgical Review

, Volume 40, Issue 2, pp 259–266 | Cite as

Stereotactic radiosurgery as a feasible treatment for intramedullary spinal arteriovenous malformations: a single-center observation

  • Sherif Rashad
  • Toshiki EndoEmail author
  • Yoshihiro Ogawa
  • Kenichi Sato
  • Hidenori Endo
  • Yasushi Matsumoto
  • Akira Takahashi
  • Teiji Tominaga
Original Article

Abstract

Spinal cord intramedullary arteriovenous malformations are rare. For patients suffering from either hemorrhage or myelopathy, surgical or endovascular interventions are indicated. However, complete eradication of the nidus is often difficult because of its intramedullary location and complex angioarchitecture. In this report, we evaluate the feasibility and safety of stereotactic radiosurgery as a treatment modality for intramedullary spinal arteriovenous malformations (AVMs). Between 2010 and 2014, we performed stereotactic radiosurgery to treat four patients with intramedullary AVM and one with spinal arteriovenous metameric syndrome (one woman and four men; age range, 31–66 years). Three patients presented with myelopathy, and two suffered hemorrhages. Nidi were located in the cervical (three cases) and thoracic (two cases) spinal cord regions. Based on the angioarchitecture, surgery and endovascular embolization were indicated. When both modalities were deemed hazardous, radiosurgery using CyberKnife™ was offered. Radiation using marginal doses of 18 Gy was administered in three fractions. The mean follow-up period was 37.2 months (range, 16–62 months). After treatment, two of the three patients with myelopathy experienced either improvement or stabilization of their symptoms and one experienced worsening of dysesthesia. In two patients with hemorrhage, symptoms improved in one and remained stable in the other. No further hemorrhagic episodes were evident during follow-up. Follow-up angiograms showed marked shrinkage of the nidus located in the thoracic spinal cord in one case and angiographic stabilization in the others. As a treatment modality for intramedullary AVMs, CyberKnife™ is safe and can be considered when surgery or endovascular therapy is not indicated. To determine optimum radiation doses and protocols for treating spinal AVMs, further studies with more patients and long-term follow-up are required.

Keywords

Arteriovenous malformation CyberKnife Intramedullary Myelopathy Spinal cord 

Notes

Acknowledgments

We thank Enago (www.enago.jp) for the English review.

Compliance with ethical standards

Financial support

None.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sherif Rashad
    • 1
  • Toshiki Endo
    • 1
    Email author
  • Yoshihiro Ogawa
    • 4
  • Kenichi Sato
    • 3
  • Hidenori Endo
    • 1
  • Yasushi Matsumoto
    • 3
  • Akira Takahashi
    • 2
  • Teiji Tominaga
    • 1
  1. 1.Department of Neurosurgery, Graduate School of MedicineTohoku UniversitySendaiJapan
  2. 2.Department of Neuroendovascular Therapy, Graduate School of MedicineTohoku UniversitySendaiJapan
  3. 3.Department of Neuroendovascular TherapyKohnan HospitalSendaiJapan
  4. 4.Sendai Radiation Oncology and Imaging ClinicSendaiJapan

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