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  • CyberKnife Stereotactic Radiosurgery for the Treatment of Symptomatic Vertebral Hemangiomas: A Single Institution Experience

    Final Number:

    Michael Zhang MD; Yi-Ren Chen MD MPH; Steven D. Chang MD; Anand Veeravagu MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Symptomatic vertebral hemangiomas (SVH) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given their relative rarity and difficulty in assessment, we sought to present a dedicated series of SVH treated by stereotactic radiosurgery (SRS) to provide insight into clinical decision-making.

    Methods: A retrospective review of a single institution’s experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. We report and analyze the treatment course of five patients with seven lesions, two of which were treated primarily by SRS.

    Results: Of the five patients studied, four presented with a chief complaint of refractory pain. Three patients reported dysesthesias, and two reported upper extremity weakness. Following radiosurgery, 4/5 patients exhibited improvement of their primary symptoms, three for pain and one for weakness, achieving clinical response after a mean period of 1 year. In two cases there was 20-40% lesion reduction in size in the most radiographically responsive dimension. All treatments were well tolerated.

    Conclusions: SRS for SVH is a safe and feasible treatment strategy, comparable to prior RT studies, and in select cases may successfully confer delayed, decompressive effects. Additional reporting will determine future patient selection and how conformal SRS treatment can best be administered.

    Patient Care: Cyberknife treatment to symptomatic vertebral hemangiomas have been infrequently described in the literature. We hope to report on the efficacy and clinical outcomes of this treatment modality.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the outcomes of radiosurgery treatment to symptomatic vertebral hemangiomas.

    References: 1. Adler JR, Jr., Murphy MJ, Chang SD, Hancock SL: Image-guided robotic radiosurgery. Neurosurgery 44:1299-1306; discussion 1306-1297, 1999 2. Ahn H, Jhaveri S, Yee A, Finkelstein J: Lumbar vertebral hemangioma causing cauda equina syndrome: a case report. Spine (Phila Pa 1976) 30:E662-664, 2005 3. Aksu G, Korcum AF: Symptomatic Vertebral Hemangioma: Results of Radiotherapy. Journal of Musculoskeletal Pain 16:318-325, 2009 4. Blecher R, Smorgick Y, Anekstein Y, Peer A, Mirovsky Y: Management of symptomatic vertebral hemangioma: follow-up of 6 patients. J Spinal Disord Tech 24:196-201, 2011 5. Bremnes RM, Hauge HN, Sagsveen R: Radiotherapy in the treatment of symptomatic vertebral hemangiomas: technical case report. Neurosurgery 39:1054-1058, 1996 6. Chang SD, Adler JR, Jr.: Current status and optimal use of radiosurgery. Oncology (Williston Park) 15:209-216; discussion 219-221, 2001 7. Chang SD, Main W, Martin DP, Gibbs IC, Heilbrun MP: An analysis of the accuracy of the CyberKnife: a robotic frameless stereotactic radiosurgical system. Neurosurgery 52:140-146; discussion 146-147, 2003 8. Chang UK, Rhee CH, Youn SM, Lee DH, Park SQ: Radiosurgery using the Cyberknife for benign spinal tumors: Korea Cancer Center Hospital experience. J Neurooncol 101:91-99, 2011

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