| Contribution of technological progress, inter-operator difference and experience of operators in Gamma Knife radiosurgery for arteriovenous malformation. | |
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MedLine Citation:
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PMID: 21279394 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Outcomes of microsurgical resection for cerebral arteriovenous malformation (AVM) largely depend on the skill and experience of the operator, but it is still unknown whether such individual differences similarly exists in stereotactic radiosurgery (SRS) for AVM. The purpose of this study was to assess the influence of the inter-operator difference and technological progress in SRS for AVM. METHODS: During the past 20 years, 514 patients with AVM were treated by SRS by four neurosurgeons. Until 1992, angiography was solely used for dose planning, and computed tomography (CT) or magnetic resonance imaging (MRI) was jointly used thereafter. In the early years, dose planning was calculated with the first-generation computer system, KULA, and manually superimposed on the radiographical images. After 1998, treatment planning was made on the computer monitor with sophisticated dose-planning software, GammaPlan. The influence of inter-operator difference, the operator's experience, and radiographical or radiosurgical technologies on the rates of obliteration and morbidity was assessed by multivariate analyses. RESULTS: The factors associated with higher obliteration rates were higher margin dose (p = 0.003) and the presence of hemorrhagic event before SRS (p = 0.002). There was no significant difference in either obliteration rate or morbidity among the five operators. However, after introduction of CT and MRI on dose planning, the risk of adverse events was significantly decreased. Especially for AVM larger than 3 cm in maximum diameter, each operator's experience (p = 0.040) and use of GammaPlan (p = 0.015) reduced morbidity. CONCLUSIONS: Inter-operator difference was not a significant factor associated with the rates of obliteration and the risk of adverse events after SRS for AVM in the multivariate analyses. Progress of the sophisticated planning software and the experience of the operator were associated with lower morbidity for larger lesions. |
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Authors:
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Tomoyuki Koga; Masahiro Shin; Keisuke Maruyama; Hiroki Kurita; Shunsuke Kawamoto; Nobuhito Saito |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-1-29 |
Journal Detail:
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Title: Acta neurochirurgica Volume: - ISSN: 0942-0940 ISO Abbreviation: - Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-1-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0151000 Medline TA: Acta Neurochir (Wien) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, kouga-tky@umin.ac.jp. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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