The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations
The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations
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DOI：
10.1056/nejmoa040907
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发表时间：
2005-01-13
影响因子：
158.5
通讯作者：
Kirino, T
中科院分区：
文献类型：
--
作者：
Maruyama, K;Kawahara, N;Kirino, T
背景：血管造影显示立体定向放射外科手术可在若干年的潜伏期后消除大多数脑动静脉畸形。然而，这种手术对出血风险的影响尚不清楚。方法：我们对500例接受伽玛刀放射手术治疗的畸形患者进行了回顾性观察研究。在三个时期评估出血率：放射术前，放射手术与血管造影记录的畸形闭塞之间（潜伏期），血管造影闭塞后。结果：放疗前记录出血42例（中位随访0.4年），潜伏期记录出血23例（中位随访2.0年），闭塞后记录出血6例（中位随访5.4年）。与诊断至放疗期间相比，潜伏期出血风险降低54%（风险比，0.46；95%可信区间，0.26 ~ 0.80；P=0.006），闭塞后出血风险降低88%（风险比，0.12；95%可信区间，0.05 ~ 0.29；P=0.006）
Background: Angiography shows that stereotactic radiosurgery obliterates most cerebral arteriovenous malformations after a latency period of a few years. However, the effect of this procedure on the risk of hemorrhage is poorly understood.Methods: We performed a retrospective observational study of 500 patients with malformations who were treated with radiosurgery with use of a gamma knife. The rates of hemorrhage were assessed during three periods: before radiosurgery, between radiosurgery and the angiographic documentation of obliteration of the malformation (latency period), and after angiographic obliteration.Results: Forty-two hemorrhages were documented before radiosurgery (median follow-up, 0.4 year), 23 during the latency period (median follow-up, 2.0 years), and 6 after obliteration (median follow-up, 5.4 years). As compared with the period between diagnosis and radiosurgery, the risk of hemorrhage decreased by 54 percent during the latency period (hazard ratio, 0.46; 95 percent confidence interval, 0.26 to 0.80; P=0.006) and by 88 percent after obliteration (hazard ratio, 0.12; 95 percent confidence interval, 0.05 to 0.29; P