Radiosurgery for Basal Ganglia, Internal Capsule, and Thalamus Arteriovenous Malformation: Clinical Outcome
Radiosurgery for Basal Ganglia, Internal Capsule, and Thalamus Arteriovenous Malformation: Clinical Outcome
复制标题
基底神经节、内囊和丘脑动静脉畸形的放射外科治疗：临床结果
作者：
Y. Andrade;Gelareh Zadeh;D. Scora;May N. Tsao;Michael L. Schwartz;D. Kondziolka;B. Pollock;Gary K. Steinberg
目的：放射外科手术被认为是治疗深部动静脉畸形（AVM）的首选方法，尽管尚未对该脑AVM亚组的临床结局进行充分研究。本研究的目的是回顾我们对这些AVM进行放射外科治疗的经验。方法：1989年10月至2000年12月，45例深部AVM（包括基底节、内囊和丘脑）患者接受了立体定向放射外科手术。3例患者失访，因此从本研究中排除。收集并分析患者特征和结局。计算并检验闭塞预测指数和基于放射外科的AVM评分。结果：42例患者随访中位时间为39个月（范围：25-90个月;平均45.8个月）。放射外科手术期间的中位最大AVM直径为1.8 cm（范围：0.9-4.0 cm;平均值：2.07 cm），中位AVM体积为2.8 cm 3（范围：0.2-18.3 cm 3;平均值：4.74 cm 3）。平均边缘剂量为16.2戈伊（中位数15戈伊），中位最大剂量为22.4戈伊（范围16.6-30戈伊）。首次放射外科治疗后，使用血管造影和磁共振成像证实闭塞的AVM治愈率为61.9%。使用闭塞预测指数预测闭塞为60%。8例患者出现放射性并发症（19%）。3例患者（7.1%）的功能缺损为一过性，5例患者（11.9%）为永久性。在该队列中，放射外科术后出血的风险在第一年为9.5%，第二年为4.7%，此后为0%。在基于放射外科的AVM评分小于1.5的组中，70%的患者实现了极好的结局（闭塞且无新的缺损），而基于放射外科的AVM评分大于1.5%的组中，40.9%的患者实现了极好的结局（P = 0.059）。结论：考虑到未经治疗的出血风险和与其他治疗方式相关的发病风险，深部AVM的放射外科治疗具有令人满意的闭塞率和可接受的发病率。
OBJECTIVE:Radiosurgery is accepted as the first option for treating deep arteriovenous malformations (AVMs), although the clinical outcome in this subgroup of brain AVMs is not well studied. The objective of this study is to review our experience with radiosurgical treatment for these AVMs. METHODS:Between October 1989 and December 2000, 45 patients with deep AVMs (including basal ganglia, internal capsule, and thalamus) underwent stereotactic radiosurgery. Three patients were lost to follow-up and therefore were excluded from this study. Patient characteristics and outcomes were collected and analyzed. The obliteration prediction index and the radiosurgery-based AVM score were calculated and tested. RESULTS:Forty-two patients were followed up for a median of 39 months (range, 25–90 mo; mean, 45.8 mo). The median maximum AVM diameter during the radiosurgery was 1.8 cm (range, 0.9–4.0 cm; mean, 2.07 cm), and the median AVM volume was 2.8 cm3 (range, 0.2–18.3 cm3; mean, 4.74 cm3). The mean marginal dose was 16.2 Gy (median, 15 Gy), and the median maximum dose was 22.4 Gy (range, 16.6–30 Gy). The AVM cure rate after the first radiosurgical treatment, using angiography- and magnetic resonance imaging-confirmed obliteration, was 61.9%. The predicted obliteration using the obliteration prediction index was 60%. Eight patients developed radiation-induced complications (19%). The deficit was transient in three patients (7.1%) and permanent in five patients (11.9%). The risk of postradiosurgical hemorrhage in this cohort was 9.5% for the first year, 4.7% for the second year, and 0% thereafter. Excellent outcome (obliteration plus no new deficit) was achieved in 70% of the patients in the group with radiosurgery-based AVM score less than 1.5 compared with 40.9% in the group with radiosurgery-based AVM score greater than 1.5% (P = 0.059). CONCLUSION:Radiosurgery for deep AVMs has a satisfactory obliteration rate and acceptable morbidity, considering the risk of hemorrhage without treatment and the risk of morbidity associated with other treatment modalities.
显微手术治疗直径小于3厘米的颅内动静脉畸形67例。
影响因子：
4.1
作者：
Sisti,MB;Kader,A;Stein,BM
通讯作者：
Stein,BM
影响因子：
4.1
作者：
Brown, RD;Wiebers, DO;OFallon, WM
通讯作者：
OFallon, WM
影响因子：
8.3
作者：
Hartmann, A;Mast, H;Young, WL
通讯作者：
Young, WL