Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations
Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations
复制标题
DOI：
10.1097/00006123-199703000-00001
复制
发表时间：
1997-03-01
期刊：
影响因子：
4.8
通讯作者：
Steiner, L
中科院分区：
文献类型：
--
作者：
Karlsson, B;Lindquist, C;Steiner, L
目的：明确脑动静脉畸形（AVM）闭塞的重要因素，从而预测闭塞的可能性。方法：在1970年至1990年期间接受伽玛刀治疗的1319例患者的945例AVM中，结果：病灶闭塞率随最小剂量（最低周边剂量）和平均剂量的增加而增加，随AVM体积的增加而降低。AVM的最小剂量是治疗结果的决定性剂量因素。最小剂量越高，完全闭塞的可能性越高。说明这一关系的曲线以图解方式增加到87%的值。较高的平均剂量缩短了AVM闭塞的潜伏期。对于闭塞病例，畸形越大，使用的最小剂量越低。这促使我们将闭塞率与产品最小剂量（AVM体积）（1/3）（K指数）相关联。闭塞率随K指数线性增加，直至约27的值，并且对于更高的K值，闭塞率具有约80%的恒定值。对于接受至少25戈伊最小剂量治疗的273例患者，研究终点（定义为2年潜伏期）的闭塞率为80%（95%置信区间= 75-85%）。如果将超过终点发生的闭塞包括在内，闭塞率增加到85%（81-89%）。结论：伽玛刀治疗后AVM的闭塞概率与AVM的最低剂量和AVM体积有关，可以用K指数进行预测。
OBJECTIVE: To define the factors of importance for the obliteration of cerebral arteriovenous malformations (AVMs), thus making a prediction of the probability for obliteration possible.METHODS: In 945 AVMs of a series of 1319 patients treated with the gamma knife during 1970 to 1990, the relationship between patient, AVMs, and treatment parameters on the one hand and the obliteration of the nidus on the other was analyzed.RESULTS: The obliteration rate increased both with increased minimum (lowest periphery) and average dose and decreased with increased AVM volume. The minimum dose to the AVMs was the decisive dose factor for the treatment result. The higher the minimum dose, the higher the chance for total obliteration. The curve illustrating this relation increased logarithmically to a value of 87%. A higher average dose shortened the latency to AVM obliteration. For the obliterated cases, the larger the malformation, the lower the minimum dose used. This prompted us to relate the obliteration rate to the product minimum dose (AVM volume)(1/3) (K index). The obliteration rate increased linearly with the K index up to a value of approximately 27, and for higher K values, the obliteration rate had a constant value of approximately 80%. For the group of 273 cases treated with a minimum dose of at least 25 Gy, the obliteration rate at the study end point (defined as 2-yr latency) was 80% (95% confidence interval = 75-85%). If obliterations that occurred beyond the end point are included, the obliteration rate increased to 85% (81-89%).CONCLUSION: The probability of obliteration of AVMs after gamma knife surgery is related both to the lowest dose to the AVMs and the AVM volume, and it can be predicted using the K index.