Fatima Nida, Meola Antonio, Ding Victoria Y, Pollom Erqi, Soltys Scott G, Chuang Cynthia F, Shahsavari Nastaran, Hancock Steven L, Gibbs Iris C, Adler John R, Chang Steven D
Departments of1Neurosurgery and.
2Radiation Oncology, Stanford University School of Medicine, Stanford, California.
J Neurosurg. 2021 Apr 2;135(6):1725-1741. doi: 10.3171/2020.9.JNS201484. Print 2021 Dec 1.
The CyberKnife (CK) has emerged as an effective frameless and noninvasive method for treating a myriad of neurosurgical conditions. Here, the authors conducted an extensive retrospective analysis and review of the literature to elucidate the trend for CK use in the management paradigm for common neurosurgical diseases at their institution.
A literature review (January 1990-June 2019) and clinical review (January 1999-December 2018) were performed using, respectively, online research databases and the Stanford Research Repository of patients with intracranial and spinal lesions treated with CK at Stanford. For each disease considered, the coefficient of determination (r2) was estimated as a measure of CK utilization over time. A change in treatment modality was assessed using a t-test, with statistical significance assessed at the 0.05 alpha level.
In over 7000 patients treated with CK for various brain and spinal lesions over the past 20 years, a positive linear trend (r2 = 0.80) in the system's use was observed. CK gained prominence in the management of intracranial and spinal arteriovenous malformations (AVMs; r2 = 0.89 and 0.95, respectively); brain and spine metastases (r2 = 0.97 and 0.79, respectively); benign tumors such as meningioma (r2 = 0.85), vestibular schwannoma (r2 = 0.76), and glomus jugulare tumor (r2 = 0.89); glioblastoma (r2 = 0.54); and trigeminal neuralgia (r2 = 0.81). A statistically significant difference in the change in treatment modality to CK was observed in the management of intracranial and spinal AVMs (p < 0.05), and while the treatment of brain and spine metastases, meningioma, and glioblastoma trended toward the use of CK, the change in treatment modality for these lesions was not statistically significant.
Evidence suggests the robust use of CK for treating a wide range of neurological conditions.
射波刀（CK）已成为一种有效的、无需框架且无创的治疗多种神经外科疾病的方法。在此，作者进行了广泛的回顾性分析并查阅文献，以阐明在其机构中CK用于常见神经外科疾病管理模式的趋势。
分别使用在线研究数据库和斯坦福大学对接受CK治疗的颅内和脊髓病变患者的研究资料库，进行了文献综述（1990年1月至2019年6月）和临床回顾（1999年1月至2018年12月）。对于每种考虑的疾病，确定系数（r2）被估计为CK随时间使用情况的一种度量。使用t检验评估治疗方式的变化，在0.05的α水平评估统计学显著性。
在过去20年中，超过7000例接受CK治疗各种脑和脊髓病变的患者中，观察到该系统使用呈正线性趋势（r2 = 0.80）。CK在颅内和脊髓动静脉畸形（AVM；r2分别为0.89和0.95）、脑和脊柱转移瘤（r2分别为0.97和0.79）、脑膜瘤（r2 = 0.85）、前庭神经鞘瘤（r2 = 0.76）和颈静脉球瘤（r2 = 0.89）等良性肿瘤、胶质母细胞瘤（r2 = 0.54）以及三叉神经痛（r2 = 0.81）的治疗中变得突出。在颅内和脊髓AVM的管理中，观察到向CK治疗方式转变存在统计学显著差异（p < 0.05），虽然脑和脊柱转移瘤、脑膜瘤和胶质母细胞瘤的治疗有使用CK的趋势，但这些病变治疗方式的变化无统计学显著意义。
有证据表明CK在治疗广泛的神经系统疾病中得到了广泛应用。
