Highlights
- •Radiosurgery is a promising treatment option for spinal arteriovenous malformations.
- •64 cases of spinal AVM treated with radiosurgery identified.
- •Good outcomes observed in 92.2%.
- •No reported cases of neurologic worsening after radiosurgery.
- •No reported cases of hemorrhage after radiosurgery.
Abstract
Spinal arteriovenous malformations (AVMs) comprise a group of complex vascular lesions
whose treatment with microsurgery or transarterial embolization can be challenging.
Stereotactic radiosurgery is a well-established treatment for intracranial AVMs, and
spinal radiosurgery and fractionated radiotherapy are common treatments for spinal
tumors of both primary and metastatic origin. The use of radiosurgery and fractionated
radiotherapy for the treatment of spinal arteriovenous malformations, however, has
been infrequently reported. Spinal stereotactic radiosurgery is emerging as a promising
option for the treatment of these lesions. We conducted a systematic review of English
language articles reporting one or more cases of spinal radiosurgery or fractionated
radiotherapy for the treatment of spinal arteriovenous fistulas (AVFs) or arteriovenous
malformations. Eight unique studies comprising 64 patients were identified. All treated
lesions consisted primarily of spinal AVMs, either intramedullary or metameric. Most
were treated with CyberKnife technology. Marginal doses in the most current studies
ranged from 18 to 21 Gy given over 2–4 fractions. In aggregate, good outcomes were
reported in 92.2% with no instances of post-treatment hemorrhage over a mean follow-up
time of 46.8 months. Angiographic follow-up showed the nidus to be obliterated in
16%, decreased in 44.6%, and unchanged in 39.3%. Stereotactic radiosurgery for spinal
arteriovenous malformations holds promise as a safe and potentially effective option
in the treatment of these rare but complex lesions.
Keywords
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Article info
Publication history
Published online: January 21, 2019
Accepted:
December 22,
2018
Received:
December 11,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
