The technical evolution of gamma knife radiosurgery for arteriovenous malformations.

The technical evolution of gamma knife radiosurgery for arteriovenous malformations. Prog Neurol Surg. 2013;27:22-34 Authors: Lunsford LD, Niranjan A, Kano H, Kondziolka D Abstract Gamma Knife stereotactic radiosurgery was first applied for the treatment of an intracranial arteriovenous malformation (AVM) in 1968. Using biplane angiography to target a small-volume, deep-seated lesion, photons were cross-fired on the pathological shunt. The AVM was obliterated within 3 years. This began a cautious introduction of Gamma Knife radiosurgery in the 1970s. As the Gamma Knife technology spread to sites in Europe, South America and the USA in the 1980s, AVM radiosurgery became a primary indication. During the early years the usual standard was to deliver a single radiosurgical isocenter to the target defined by 2-dimensional angiography. Most patients had small-volume AVMs unsuitable for surgical excision. Over time the technique of Gamma Knife AVM surgery evolved to include: careful patient selection, discussion of appropriate treatment strategies, anticonvulsant administration for lobar locations and intraoperative targeting using both high-resolution axial plane imaging--usually magnetic resonance imaging--coupled with biplane digital subtraction angiography. High-speed computer dose planning integrated with more detailed imaging strategies facilitated conformal radiation delivery in a single treatment session coupled with high selectivit...
Source: Progress in Neurological Surgery - Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research