Extracranial Treatment of a C2-C3 Level Intramedullary AVM
Patient History
A 41-year-old female presented with a history of 3 intraspinal bleeds over 15 years from a right cervical spinal cord arteriovascular malformation at the C2-C3 level. As a result of these hemorrhages, the patient developed a disabling and progressive spastic quadraparesis with Brown-Sequard syndrome. She also reported a signifcant and increasing loss of function in her right hand.
CyberKnife Advantage
The patient was not a candidate for microsurgical resection or embolization due to the intramedullary nature of the AVM. The lesion was also located below the limit of conventional frame-based radiosurgical systems.
Treatment
The patient was treated on the frameless CyberKnife System at Stanford University with 3 fractions to a total peripheral dose of 21 Gy.
Outcome & Follow-Up
One year post-treatment, the patient displayed improved cervical spinal cord function including improvement in right hand function and gait. Two years post-treatment, repeat MRI scans revealed the size of the AVM had significantly decreased with significant reduction in vascularity as determined by the size and number of flow voids.
Location
Stanford University Medical Center, Stanford, CA USA
