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Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.

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タイトル: Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.
著者: Hida, Kazutoshi 著作を一覧する
Shirato, Hiroki 著作を一覧する
Isu, Toyohiko 著作を一覧する
Seki, Toshitaka 著作を一覧する
Onimaru, Rikiya 著作を一覧する
Aoyama, Hidefumi 著作を一覧する
Ushikoshi, Satoshi 著作を一覧する
Miyasaka, Kazuo 著作を一覧する
Iwasaki, Yoshinobu 著作を一覧する
キーワード: arteriovenous malformation
spine
intramedullary
radiation therapy
subarachnoid hemorrhage
発行日: 2003年 7月
出版者: American Association of Neurological Surgeons
誌名: Journal of Neurosurgery
巻: 99
号: 1
開始ページ: 34
終了ページ: 38
抄録: Object. Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. Methods. Candidates for this study were patients who experienced symptoms due to an intramedullary AVM but were ineligible for embolization or surgery. Of 21 patients with spinal AVMs, 10 cases in a 10-year period met this criterion. Angiography and contrast-enhanced computerized tomography scanning were used for treatment planning in all cases. Fractionated radiotherapy was performed using a linear accelerator, extracranial immobilization system, and frequent orthogonal linacographic verification. The starting radiation dose was 32 Gy in two, 36 Gy in three, and 40 Gy in two patients, in a regimen involving 1.8 to 2–Gy daily fractions; this was recently changed to a hypofractionation schedule of 30 Gy (in eight sessions) in one and 20 Gy (in four sessions) in two patients. Results. The follow-up period ranged from 26 to 124 months (median of 49 months). There were no hemorrhages nor any adverse reactions attributable to irradiation. Of the seven patients who consented to undergo follow-up angiography, the nidus size decreased in five, but complete obliteration did not occur in any patient. Conclusions. Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
Rights: The final version of the paper was published in J Neurosurg (Spine 1) 99:34–38, 2003. For reuse of any of the materials, including editorial copy, figures, or tables please contact the Journal of Neurosurgery at jneuro@virginia.edu
Relation (URI): http://www.thejns-net.org/spine/issues/v99n1/abs/s0990034_fs.html
資料タイプ: article (author version)
URI: http://hdl.handle.net/2115/14693
出現コレクション:雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

提供者: 飛騨 一利

 

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