Stereotactic heavy charged particle Bragg peak radiosurgery

Deep and surgically-inaccessible intracranial arteriovenous malformations (AVMs) have not been treated until the last two decades, primarily because of their variable symptoms, changeable pathoanatomical relationships, and inaccessibility to vascular brain surgery. Recently developed neuroradiological imaging and microsurigical techniques are now making certain of the deep AVMs potentially amenable to treatment. However, serious limitations to neurovascular surgical or interventional neuroradiological procedures may exist in the case of deep AVMs, because of location, size, patient condition, or other factors. Conventional radiotherapy as a method of induced thrombosis has been attempted in the past, but has been generally abandoned as unsuccessful. However, stereotactic heavy charged-particle Bragg-peak radiosurgery currently being developed holds considerable promise for the treatment of those life-threatening intracranial vascular disorders that are surgically inaccessible. Evaluation and treatment with stereotactically directed narrow beams of heavy ions in approximately 225 patients in our laboratory, plus extensive clinical and neuroradiological follow up, indicates that heavy charged particle radiosurgery obliterates intracranial arteriovenous malformations or protects against rebleeding with considerable reduction in mobility and mortality. 6 figs