Since 2013 we have been using a Cyberknife M6TM system
Painless and gentle treatment of arteriovenous malformation (Angioma)
The Cyberknife method has already been well approved for treatment of specific tumors in the brain, the spine and other parts of the body. For arteriovenous malformations (angiomas) it offers a painless, out-patient and gentle treatment option. The non-invasive Cyberknife therapy has been applied to more than 100,000 tumor patients worldwide.
Cyberknife preserves quality of life
The outpatient Cyberknife (radiosurgery) treatment of an arteriovenous malformation (angioma) does not entail substantial restrictions of the patients’ daily routine. The Cyberknife therapy preserves the patients’ quality of life. In most instances usual activities can be pursued the day after treatment of vascular anomaly.
Arteriovenous malformations (AVM) or angiomas are usually congenital vascular malformations, which consist of a short circuit of afferent vessels (arteries) and outgoing vessels (vein).
By angioma (AVM) different symptoms can be triggered. In common headache, seizures and paralysis, and depending on the location of the angioma also speech or memory-efficient interference occurs. However, the main problem with angioma is a risk of brain hemorrhage occurring spontaneously. Here the risk of bleeding is specified in larger studies with AV angiomas with a bleeding probability of about 1 to 2 percent per year. For very large angiomas that have already been bleeding, the propensity for bleeding is higher.
A basic distinction between asymptomatic angiomas, ie arteriovenous malformation who have not bled and caused no neurological deficits, as well as symptomatic angioma, for example, cause headaches, seizures or neurological deficits or have already caused a brain hemorrhage.
Following the angiographic diagnosis, arteriovenous malformation (AVM) can be due to the size, the location and the hemodynamics closer to classify (Spetzler-Martin classification). On the basis of angiography detailed planning and discussion of other methods for the treatment of angioma are possible.
In principle, three treatment methods are available:
Endovascular treatment, that is, the closure of the afferent and efferent vessels or particles with adhesive as well as with small spirals over a catheter that is introduced into the angioma
Needs: surgery, anaesthesia, hospital stay
Radiosurgery (Cyberknife), ie, targeted single irradiation of the angioma nidus, which is located in the center of the angioma bundle and thus cause irradiation-induced closure of angioma vessels and protection of the remaining cerebral blood flow in the long term.
Needs: outpatient procedure, painfree
Microsurgical treatment, that is, the complete removal of the angioma with selective occlusion of the incoming and outgoing vessels while sparing the surrounding brain vessels.
Needs: surgery, anaesthesia, hospital stay
Treatment goal
The aim of the treatment is to close the angioma completely, because only in that case no further risk of bleeding is to be expected. The individual treatment method always has to be carefully considered, because not every angioma can be treated by endovascular or radiosurgery or surgery with the same opportunities and risks. Optionally, the combination of different treatment methods is necessary in order to achieve an angioma closure.
Since these are complex medical issues, it is important to discuss the various treatment options with a view to the individual case of disease. At the Munich Cyberknife Center the individual cases are discussed in detail with the colleagues of the stroke center of the hospital Großhadern of the Klinikum der Universität München (KUM) in the context of weekly Neurovascular conferences.
Our specialized physicians and medical physicists evaluate the imaging studies and transfer the image sets (CT, MRI) to a planning computer for Cyberknife treatment. The dosage and direction of the rays are computed for the treatment based on exact definition of the tumor and surrounding healthy structures. Depending on the location and size of the lesion, this can take up to 24 hours.
The treatment day begins with usual breakfast. Also, medications can be taken as usually. At the Munich Cyberknife Center the patient will be welcomed and prepared for the treatment by our medical and office team. In a comfortable reclining position (on request with your favorite music in the background) the patient stays in touch with our treatment team throughout the medical application by the use of more than one camera and microphone. The Cyberknife treatment is usually a one-time treatment; but it can be repeated if new treatable tumors occur in the future. It lasts – depending on the size - an average of about 30 minutes. The treatment can be stopped anytime to visit the toilet or to drink something. Thereafter, the treatment is continued unchanged. After the treatment there is a closing meeting to discuss the medication and the intervals of the follow-up investigations. An inpatient hospital stay after the treatment is not required.
Regular clinical checks and imaging controls help to document the healing process. A first visit is provided - depending on the diagnosis - 3 to 6 months after treatment. As a rule, a new CT or MRI examination is required.
