Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery
Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery
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DOI：
10.1227/01.neu.0000043692.51385.91
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发表时间：
2003-02-01
期刊：
影响因子：
4.8
通讯作者：
Bradshaw, P
中科院分区：
文献类型：
--
作者：
Friedman, WA;Bova, FJ;Bradshaw, P
目的：本研究旨在确定哪些因素在统计学上可预测放射学和临床结局。在放射外科。方法：对269例脑动静脉畸形（AVM）患者的计算机化剂量测定和临床资料进行回顾性分析。在通过病灶的连续增强计算机断层扫描切片上手动勾画AVM病灶轮廓，以详细确定病灶体积、靶点缺失、正常脑、治疗组织、剂量适形性和剂量梯度。此外，一些患者和治疗因素，包括Spetzler-Martin分级，症状，剂量，等中心点，放射学结果和临床outcome. Results的数量，进行了多变量analysis.Results：二百二十五名患者进行了治疗与放射外科的第一次，和44例患者进行了放射外科再治疗。143例患者的AVM位于“功能区”或其附近，126例患者没有; 70例患者表现出与AVM相关的术前神经学结果，199例患者没有。26例患者既往接受过血管内治疗，10例患者既往接受过AVM手术治疗。在269例研究患者中，228例未发生并发症，10例（3.7%）发生了短暂性放射诱导并发症，3例（1%）发生了永久性放射诱导并发症，28例（10%）发生了治疗后出血。结论：在本研究中，分析的因素均不能预测放射手术后出血。12-戈伊剂量可预测硬膜外并发症。明确的AVM位置和12-戈伊的体积与短暂辐射引起的并发症的发生相关。更好的适形性与短暂并发症的发生率降低相关。较低的Spetzler-Martin分级、较高的剂量和较陡的剂量梯度与放射学成功相关。
OBJECTIVE: This study was undertaken to determine which factors were statistically predictive of radiological, and clinical outcomes. in the radiosurgical. treatment-of arteriovenous malformations (AVMs).METHODS: The computerized dosimetric and clinical data for 269 patients were reviewed. The AVM nidus was hand-contoured on successive enhanced computed tomographic slices through the nidus, to allow detailed determinations of nidus volume, target miss, normal brain, tissue treated, dose conformality, and dose gradient. In addition, a number of patient and treatment factors, including Spetzler-Martin grade, presenting symptoms, dose, number of isocenters, radiological outcome, and clinical outcome, were subjected to multivariate analysis.RESULTS: Two hundred twenty-five patients were treated with radiosurgery-for the first time, and 44 patients underwent radiosurgical retreatment. One hundred forty-three-patients had AVMs located in or near "eloquent" brain areas and 126 patients did not; Seventy patients demonstrated preoperative neurological findings related to the AVM and 199, did not. Twenty-six patients had previously undergone endovascular treatment and 10 patients had previously undergone surgical treatment of their AVMs. Of the 269 patients studied, 228 experienced no complication, 10 (3.7%) experienced a transient radiation-induced complication, 3 (1 %) experienced a permanent radiation-induced complication, and 28 (10%) experienced posttreatment hemorrhage.CONCLUSION: None of the analyzed factors was predictive of hemorrhage after radio-surgery in this study. The 12-Gy volume was predictive of permarientracli complications. Eloquent AVM location and 12-Gy volume were correlated with the occurrence of transient radiation-induced complications. Better conformality was correlated with a reduced incidence of transient complications. Lower Spetzler-Martin grades, higher doses, and steeper dose gradients were correlated with radiological success.