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CyberKnife® Patient Support Group > Ask the Doctors > AVM > CK treatment 6 months after craniotomy  Forum Quick Jump
 
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tracy
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   Posted 10/17/2005 5:52 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Hi. I am looking for info about the CK for my sister. She had an AVM that was embolized at University of Penn. Hosp. in Philadelphia. She underwent a craniotomy to remove the AVM, but part of it was too deep for them to reach. After surgery she developed an infection in the bone that was removed for the craiotomy and had to have a prosthetic bone put in to replace the infected skull bone. The doctors at the hosp. are now recommending gamma knife surgery for the remainder of the AVM. They are trying to figure out if it is possible for them to do as the prosthetic bone in back of her head won’t allow them to put screws in for the stereotactic frame. My question is this: Would she be a candidate for CK surgery, which doesn’t use the frame? And also if you have to do MRI’s for the CK, because she also can’t have them done because of the prosthetic bone. U of Penn Hosp. does not yet have all that is needed for these treatments, could she be referred to another hosp. that is using CK tratments. She lives in Scranton, Pa. Thank you for your help.
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radsrus
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   Posted 10/18/2005 1:56 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
THe problems you mention would not keep her from having CK treatment. It would require some fancy CT scans, but can be done. Redbank NJ has a CK but they are relatively new and I cannot tell you whether they are prepared to do the kind of scanning needed. Dr. Kaufman or Dr. Rosenblum there can tell you. You could also contact Dr. Irving Kaplan at Beth Israel in Boston. Pittsburgh has a CK but my understanding is that they only do extracranial cases with it. THere is a CK in Summit NJ but I don’t know the doctors there. THere are very busy centers at Georgetown in DC and Sinai in Baltimore. I would suggest you contacting one or more of these centers and see who can do the procedure. You can get contact information at accuray.com


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

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tracy
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   Posted 10/18/2005 7:20 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Thank you very much for your reply. I will look into the Summit location and speak to someone there.

Should we have her doctors in Philly call the center in Summit or should we contact them ourselves as if it was for a second opinion?
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radsrus
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   Posted 10/18/2005 2:40 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
You can contact themselves, and they can get records as needed.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

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Steven Chang, MD
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   Posted 10/18/2005 3:31 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
If the AVM has a compact nidus and is well visualized on CT and/or MRI scan, it should be no problem treating with the Cyberknife. In cases where the AVM is tiny or not well visualized on CT and MRI, then an angio would be required and that may require a frame based treatment. I am a little surprised that they felt they could not get the frame on the head due to the prior craniotomy, as it generally is possible to use the frame even after a craniotomy as long as there is careful placement of the pins.

Steven D. Chang, MD
Assistant Professor
Department of Neurosurgery
Stanford University School of Medicine
300 Pasteur Dr., Room R-225
Stanford, CA 94305
Tel (650)723-5573
Fax (650)725-5032
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tracy
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   Posted 10/19/2005 7:07 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
The avm is the type where they would need to do the angio to get the correct location. Does this mean that Gamma Knife would be the better choice? She told me that they aren’t going to need the frame to do the angio, so would Cyber knife still be a good choice? The avm is 2 cm in size, in the occipital lobe, she also has an aneurysm in the frontal lobe that was closed off by inserting a coil placed there during an angio. She is worried that if she seeks the opinion of the CK doctors, they will tell her she should have the CK procedure and that the Gamma Knife doctors will recommend Gamma knife surgery. Basically, she wants the procedure that best suits her situation and has the least risk of side effects. The Overlook Hosp. facility only does CK and the Penn. doctors only have the Gamma Knife. We will get the opinion of both and hopefully be able to make the right choice.

I suppose that either peocedure would be better than the risk of a bleed or future craniotomies.
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radsrus
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   Posted 10/19/2005 5:24 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
There are several physician groups in the country that have both Gamma Knife and CyberKnife. I don’t claim to have a comprehensive list, but these are the ones I know (the doctor names are the ones with whom I am most familiar):
St. Anthony Hospital, Oklahoma City, OK (Dr. Medbery)
Menorah Medical Center, Shawnee Mission, KS (Dr. William Rosenberg)
Baylor, Dallas, TX (Dr. Brian Berger)
Methodist Cancer Center, San Antonio, TX (Dr. Ardow Ameduri)
St. Joseph’s Hospital/Barrow Neurological Institute, Phoenix, AZ (Dr. John Kresl)

I’m sure that there are probably others, who will see this post and promptly let me know of their existence, thus allowing me to compile a more complete list for other nefarious purposes.

We would be happy to review the images in our conference and give you an opinion. You could still get the treatment up there. I suspect the same is true of the other centers.

I would not indefinitely delay treatment, but after radiosurgery there is still a bleeding risk for up to 2 years, so delaying by a couple of weeks to get all the opinions you want would be worthwhile.

Treatment with the Gamma Knife in our hands has usually involved angiography the day of the treatment, although I think Dr. Chang is right in saying that it may not always be necessary. With a fast enough scanner the CT angiogram can be used instead, which is easier with the CK. The CK is frameless which you may or may not consider a benefit. GK treatment is all done in a single day, while CK treatment usually involves at least two visits for scanning and later treatment. Some people are fractionating treatment for AVM’s I think, but we have not branched out into that yet. I personally think that single fraction treatment, whether with GK or CK, remains the gold standard for radiosurgical treatment. The coiled aneurysm should not represent a significant roblem.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

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tracy
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   Posted 10/20/2005 5:18 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Thank you, Dr. Medbery and Dr. Chang. I really appreciate you insights. I will get the images to you when she gets them. Again, thank you very much!
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