Abstract：
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.
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.
摘要：
目的：射波刀（CK）已成为一种有效的无框和非侵入性方法，用于治疗多种神经外科疾病。这里,作者进行了广泛的回顾性分析和文献综述,以阐明其所在机构在常见神经外科疾病管理范式中使用CK的趋势.
方法：使用文献综述（1990年1月至2019年6月）和临床综述（1999年1月至2018年12月），分别,在斯坦福接受CK治疗的颅内和脊柱病变患者的在线研究数据库和斯坦福研究存储库。对于所考虑的每种疾病，测定系数(r2)被估计为随时间变化的CK利用率的量度。使用t检验评估治疗方式的变化，在0.05α水平评估具有统计学意义。
结果：在过去20年中，有超过7000名接受CK治疗的患者患有各种脑和脊髓病变，在系统的使用中观察到正线性趋势（r2=0.80）。CK在颅内和脊髓动静脉畸形（AVM；分别为r2=0.89和0.95）的治疗中获得了突出地位;脑和脊柱转移（分别为r2=0.97和0.79）;良性肿瘤，例如脑膜瘤（r2=0.85），前庭神经鞘瘤（r2=0.76），和颈静脉血管球瘤（r2=0.89）；胶质母细胞瘤（r2=0.54）；和三叉神经痛（r2=0.81）。在颅内和脊髓AVM的管理中观察到治疗方式对CK的变化具有统计学意义（p<0.05），在治疗脑和脊柱转移瘤的同时，脑膜瘤,胶质母细胞瘤倾向于使用CK，这些病变的治疗方式变化无统计学意义.
结论：有证据表明CK用于治疗广泛的神经系统疾病。
方法：使用文献综述（1990年1月至2019年6月）和临床综述（1999年1月至2018年12月），分别,在斯坦福接受CK治疗的颅内和脊柱病变患者的在线研究数据库和斯坦福研究存储库。对于所考虑的每种疾病，测定系数(r2)被估计为随时间变化的CK利用率的量度。使用t检验评估治疗方式的变化，在0.05α水平评估具有统计学意义。
结果：在过去20年中，有超过7000名接受CK治疗的患者患有各种脑和脊髓病变，在系统的使用中观察到正线性趋势（r2=0.80）。CK在颅内和脊髓动静脉畸形（AVM；分别为r2=0.89和0.95）的治疗中获得了突出地位;脑和脊柱转移（分别为r2=0.97和0.79）;良性肿瘤，例如脑膜瘤（r2=0.85），前庭神经鞘瘤（r2=0.76），和颈静脉血管球瘤（r2=0.89）；胶质母细胞瘤（r2=0.54）；和三叉神经痛（r2=0.81）。在颅内和脊髓AVM的管理中观察到治疗方式对CK的变化具有统计学意义（p<0.05），在治疗脑和脊柱转移瘤的同时，脑膜瘤,胶质母细胞瘤倾向于使用CK，这些病变的治疗方式变化无统计学意义.
结论：有证据表明CK用于治疗广泛的神经系统疾病。
