Novel Approach of Linear Accelerator-Based Stereotactic Radiosurgery in an Adult Patient With Brain Arteriovenous Malformation: A Case Report and Clinical Outcome

Santosh Devarakonda,Vijay Kumar Kontham

doi:10.34172/icnj.2020.29

Abstract

Stereotactic radiosurgery (SRS) is a proven strategy for treating the central nervous system arteriovenous malformation (AVM). We intend to present a case of cerebral AVM in an adult patient, successfully treated with a linear accelerator (LINAC) based SRS using simplified setup techniques and an advanced planning system. In the current scenario, frame-based SRS is the standard of care with LINAC. Recently, it has proven that even frameless SRS has similar results. In our case, we used a frameless SRS technique with similar results. While calculating the dose in radiotherapy planning, we used the Acuros™ algorithm, which has proven dosimetric advantages compared to the traditional AAA™ algorithm.

Highlights

Central nervous system arteriovenous malformations (AVMs) are relatively rare developmental anomalies for both pediatric and adult populations
We describe a successful attempt of stereotactic radiosurgery (SRS) in an adult female with cerebral AVM
A higher incidence of radiation-induced complications has reported in children with larger volumes of AVM, Spetzler–Martin grade IV and V AVMs, and those located in the brainstem, thalamus, or basal ganglia.[1]

Summary

Introduction

Central nervous system arteriovenous malformations (AVMs) are relatively rare developmental anomalies for both pediatric and adult populations. The patient refused the option of surgery due to the risk of potential complications. Treatment This patient has booked for SRS treatment on our Varian TruebeamTM STxTM LINAC with HD MLC (high definition multi-leaf collimators) and FFF (flattening filter free) configuration. A marginal dose of 18 Gy has prescribed to planning target volume (PTV). The treatment has administered in a single fraction after meticulous QA and setup of patients with verification of Manual and automated SSD values at representative angles. Outcome and Follow-up On follow up at 12 months, the patient improved symptomatically, and MR imaging (Figure 2) revealed a decrease in the size of AVM nidus, measuring approximately 1.3 x 1.0 x1.5 cm.

Discussion

Findings

Conclusion