Successful Stereotactic Radiosurgery with the CyberKnife® of a Giant Arteriovenous Malformation of the Tongue: A Case Report

Abstract

We report a successful outcome for a large arteriovenous malformation (AVM) of the tongue treated with CyberKnife® (CK) image-based stereotactic radiosurgery (SRS). A 56-year-old man presenting with a tongue AVM underwent ligation of the lingual artery and partial resection of the nidus. Sixteen years later, his pulsating submandibular mass had enlarged. An image study revealed a remarkable re-expansion of the nidus involving the tongue and the oral floor, with a volume of 130 ml. CK SRS was performed with 2 fractions. The prescribed marginal dose was 22 Gy. Thirty-four months after SRS, angiography demonstrated complete obliteration of the nidus without major adverse effects. We conclude that CK SRS may be suitable for the treatment of AVMs in the head and neck region.

Stereotactic body radiotherapy for a large arteriovenous malformation of the head and neck

“…A single case report of successful radiosurgery of a large AVM of the tongue using the CyberKnife (Accuray, Inc., Sunnyvale, CA) system has been published. 11 Similar to our case, the patient had undergone previous surgical resection with eventual progression. The lesion, 130 mL in volume, was treated with a marginal dose of 22 Gy in two fractions.…”

“…In contrast to the robust literature on the use of SRS/SBRT for intracranial and spinal AVMs, using multifraction SBRT for head and neck AVMs is barely described. A single case report of successful radiosurgery of a large AVM of the tongue using the CyberKnife (Accuray, Inc., Sunnyvale, CA) system has been published . Similar to our case, the patient had undergone previous surgical resection with eventual progression.…”

Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations

“…The clinical context, as well as the course after treatment, is described. Both were located in the lower part of the face, which is even more rare, accounting for approximately 17% of cases, as previously reported [14]. We hypothesized that using similar radiation doses as for brain AVM would achieve obliteration with minimal complication rates.…”

“…To the best of our knowledge, here we report the first cases of extracranial AVMs treated with SRS by single-fraction GK. These are rare entities characterized by continual growth leading to the focal destruction of superficial and deep underlying tissue [14, 17]. Compared to the well-established role of SRS in the management of cerebral AVMs, very little is known about its therapeutic effect on extracranial AVMs.…”

“…Furthermore, from a stereotactic point of view, they are situated either outside the frame space or in mobile regions. Only two previous reports have described radiotherapy (RT) [13] and Cyberknife (CK; Accuray, Madison, WI, USA) SRS [14] as a treatment for these rare conditions.…”