“Early results of CyberKnife radiosurgery for arteriovenous malformations: Clinical article.”
Colombo, F., C. Cavedon, et al. (2009).
Journal of Neurosurgery 111(4): 807-819.
Object. The authors describe a method that utilizes an image-guided robotic radiosurgical apparatus (the CyberKnife) for treatment of cerebral arteriovenous malformations (AVMs). This procedure required the development of an original technique that allows a high degree of automation. Methods. Angiographic images were imported into the treatment planning software by coregistering CT and 3D rotational angiography. The nidus contour was delineated using the contouring tools of the treatment planning system. Functional MR imaging was employed for contouring critical cortical regions, such as the motor cortex and language areas. Once the radiation dose to be delivered to the target volume and dose constraints to critical structures were prescribed, the inverse treatment planning function determined the optimal treatment plan. Results. A series of 279 patients with cerebral AVMs underwent CyberKnife radiosurgery. One transitory adverse effect of the radiation procedure was observed. Eight bleeding occurrences were noted before complete AVM obliteration. Of the 102 patients with follow-up > 36 months, 80 underwent angiographic evaluation. In this group, 65 patients (81.2%) showed complete angiographic obliteration of their AVM. In 8 more patients, complete angiographic obliteration was demonstrated by MR angiography only. Conclusions. This is the first report describing a technique developed for CyberKnife radiosurgery of cerebral AVMs. The use of different imaging modalities for automatic delineation of the target and critical structures combined with the employment of the inverse treatment planning capability is the crucial point of the procedure. The procedure proved to be safe and efficient.
“Penile rehabilitation following treatment for prostate cancer: An analysis of the current state of the art.”
Shaiji, T. A., T. Domes, et al. (2009).
Journal of the Canadian Urological Association 3(1): 37-48.
Despite recent advances in surgical technique using laparoscopic and robotic approaches for the management of early organconfined prostate cancer, most contemporary reports demonstrate significant rates of erectile dysfunction comparable to standard open approaches. Controversy remains related to many of the preand postoperative management strategies, including agents to enhance inerve recovery, erectogenic drugs, antioxidants, vasoactive injectables, vacuum erection devices and inerve grafting procedures. Additionally, the optimal timing of these interventions and their duration, dose, frequency and outcome thresholds remain ill-defined. In our paper, we provide a comprehensive literature review involving both the basic and clinical data surrounding rehabilitative approaches.
“Current indications and ongoing clinical trials with CyberKnife® stereotactic radiotherapy in France in 2009.”
Thariat, J., G. Li, et al. (2009).
Indications du CyberKnife® et essais cliniques en cours en 2009 96(9): 853-864.
Image-guided frameless fractionated stereotactic radiotherapy can be performed with millimetric accuracy using the CyberKnife® (Accuray Inc. Sunnyvale, USA) equipped with an integrated tracking system for intra- and extracranial lesions. Highly conformal hypofractionated irradiation has been used to treat lesions with curative or palliative intent. It is advantageous for radioresistant tumors, re-irradiating lesions, boosting small volumes and treating tumors that move with respiration. It also limits travel costs and improves the quality of life. Over 60,000 patients have been treated worldwide using CyberKnife® including 600 patients in the three French cancer centres of Nice, Nancy and Lille. These expert Cyberknife® centres follow quality assurance programs and work together with the “Haute Autorité de santé” and the French National Cancer Institute (INCa) to promote clinical developments. The CyberKnife® has been used to treat intracranial lesions including (but not limited to) meningiomas, acoustic schwannomas, brain oligometastases, as well as skull base tumors like chordomas, or para- or intraspinal tumors, and extracranial tumors such as lung cancers. Currently, extracranial stereotactic radiotherapy is particularly attractive for tumors moving with respiration and is being evaluated in liver, prostate and re-irradiation including head and neck tumors. ©John Libbey Eurotext.
“Navigation and robotics of the lateral skull base.”
Caversaccio, M., C. Stieger, et al. (2009).
Navigation und Robotik an der Otobasis 57(10): 975-982.
Computer aided microscopic surgery of the lateral skull base is a rare intervention in daily practice. It is often a delicate and difficult minimally invasive intervention, since orientation between the petrous bone and the petrous bone apex is often challenging. In the case of aural atresia or tumors the normal an atomical landmarks are often absent, making orientation more difficult. Navigation support, together with imaging techniques such as CT, MR and angiography, enable the surgeon in such cases to perform the operation more accurately and, in some cases, also in a shorter time. However, there are no interna tionally standardised indications for navigated surgery on the lateral skull base. Miniaturised robotic systems are still in the initial validation phase. © Springer Medizin Verlag 2009.
“Blunt vascular trauma can be a consequence of robotic surgeries.”
Kadiyala, S. (2009).
Journal of minimally invasive gynecology 16(4): 516.