Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 2: Basal ganglia and thalamus arteriovenous malformations
Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 2: Basal ganglia and thalamus arteriovenous malformations
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颅内深部动静脉畸形的立体定向放射外科治疗，第 2 部分：基底节和丘脑动静脉畸形
DOI：
10.1016/j.jocn.2015.11.006
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发表时间：
2016
影响因子：
2
通讯作者：
J. Sheehan
中科院分区：
文献类型：
--
作者：
O. Cohen;D. Ding;J. Sheehan
本综述的目的是批判性地分析立体定向放射手术（SRS）治疗基底神经节和丘脑动静脉畸形（AVM）的结果。这些深层病变的处理仍然是神经外科医生面临的挑战。基底节区和丘脑的动静脉畸形与发生在更浅表部位的动静脉畸形相比，有更高的出血风险，并伴有毁灭性的发病率和死亡率。任何目前可用的治疗方式都可能失败或导致医源性神经系统恶化。最近来自一项针对未破裂性脑AVM （ARUBA）的随机试验的证据进一步阻止了具有显著治疗相关不良事件风险的积极治疗方法。显微手术切除、血管内栓塞、SRS等都是治疗AVM的重要手段。SRS是一种有效的治疗选择，对于丘脑和基底神经节的AVM，被认为是切除的高风险。与AVM的自然病史相比，SRS提供了可接受的闭塞率，在潜伏期发生出血的风险通常较低。考虑到未完全消除的病变仍有破裂的可能，当最初的SRS手术不能完全消除时，应考虑额外的治疗，如重复SRS和显微手术切除。基底节和丘脑AVM患者在SRS后需要持续的临床和放射学观察和随访，即使血管造影闭塞已被证实。
The aim of this review is to critically analyze the outcomes following stereotactic radiosurgery (SRS) for arteriovenous malformations (AVM) of the basal ganglia and thalamus. The management of these deep-seated lesions continues to challenge neurosurgeons. Basal ganglia and thalamic AVM show a higher risk of hemorrhage, and an associated devastating morbidity and mortality, as compared to AVM in more superficial locations. Any of the currently available treatment modalities may fail or result in iatrogenic neurologic deterioration. Recent evidence from A Randomized Trial of Unruptured Brain AVM (ARUBA) further deters aggressive approaches that carry a significant risk of treatment-related adverse events. Microsurgical resection, endovascular embolization and SRS all play a role in the treatment of AVM. SRS is an effective therapeutic option for AVM of the thalamus and basal ganglia that are deemed high risk for resection. SRS offers acceptable obliteration rates, with generally lower risks of hemorrhage occurring during the latency period compared to the AVM natural history. Considering that incompletely obliterated lesions still harbor the potential for rupture, additional treatments such as repeat SRS and microsurgical resection should be considered when complete obliteration is not achieved by an initial SRS procedure. Patients with AVM of the basal ganglia and thalamus require continued clinical and radiologic observation and follow-up after SRS, even after angiographic obliteration has been confirmed.
基底神经节，丘脑和岛状的深静脉畸形：多模式管理，患者选择和结果。
影响因子：
2
作者：
Potts, Matthew B.;Jahangiri, Arman;Jen, Maxwell;Sneed, Penny K.;McDermott, Michael W.;Gupta, Nalin;Hetts, Steven W.;Young, William L.;Lawton, Michael T.
通讯作者：
Lawton, Michael T.