Radiosurgery for dural arteriovenous fistulas
Radiosurgery for dural arteriovenous fistulas
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DOI：
10.1016/j.surneu.2004.12.026
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发表时间：
2005-11-01
影响因子：
--
通讯作者：
Lunsford, LD
中科院分区：
文献类型：
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作者：
Koebbe, CJ;Singhal, D;Lunsford, LD
目的：硬脑膜动静脉瘘 (DAVF) 占所有动静脉畸形的 10% 至 15%。最近的研究表明，放射外科治疗 DAVF 具有良好的效果。我们回顾性分析了接受立体定向放射外科治疗（伴或不伴栓塞）的 DAVF 患者。方法：1991 年至 2002 年间，18 例 23 例经血管造影证实有症状的 DAVF 患者接受了单独伽马刀放射外科治疗（n = 8）或联合栓塞治疗（n = 10）。进行回顾性图表审查以确定 DAVF 位置、静脉引流模式、放射外科剂量测定、临床结果和影像学结果。该系列包括 9 名男性和 9 名女性，平均年龄为 65 岁（范围 50-89）。九名患者在放射外科手术前接受颗粒、线圈和/或无水乙醇栓塞，一名患者在放射外科手术后接受颗粒栓塞。临床随访的平均持续时间为 43（范围 2 - 116）个月。平均边缘放射外科剂量为 20（范围 15 - 30）Gy。 结果：9 名患者的症状完全消失，9 名患者的症状全部消失，但 1 例除外。对 8 名患者进行了血管造影随访（平均 46 个月），证明所有病例均完全闭塞。通过磁共振血管造影或计算机断层扫描血管造影评估的 7 名患者没有显示 DAVF（4 名患者）或 DAVF 大小减小（3 名患者）的证据。放射外科手术后，1 名患者出现暂时性偏瘫。放射外科之前栓塞后发生了两次永久性神经功能缺损。治疗后没有患者出现颅内出血。结论：立体定向放射外科治疗可以有效长期缓解选定的 DAVF 患者的症状。 (c) 2005 Elsevier Inc. 保留所有权利。
Objective: Dural arteriovenous fistulas (DAVFs) comprise 10% to 15% of all arteriovenous malformations. Recent studies have demonstrated promising results when radiosurgery is used for DAVFs. We retrospectively analyzed our patients with DAVFs who received stereotactic radiosurgery with or without embolization.Methods: Between 1991 and 2002, 18 patients with 23 angiographically confirmed symptomatic DAVFs underwent gamma knife radiosurgery, either alone (n = 8) or in combination with embolization (n = 10). A retrospective chart review was performed to identify DAVF location, venous drainage pattern, radiosurgery dosimetry, clinical outcomes, and imaging results. The series included 9 men and 9 women with a mean age of 65 (range 50-89) years. Nine patients received particulate, coil, and/or absolute ethanol embolization before radiosurgery, and I patient received particulate embolization after radiosurgery. The mean duration of clinical follow-up was 43 (range 2 - 116) months. The mean margin radiosurgery dose was 20 (range 15 - 30) Gy.Results: Nine patients had complete resolution of their presenting symptoms, and 9 patients had resolution of all but I of their presenting symptoms. Angiographic follow-up (mean 46 months) was performed on 8 patients demonstrating complete obliteration in all the cases. Seven patients evaluated by magnetic resonance angiography or computed tomography angiography showed no evidence of DAVF (4 patients) or decreased DAVF size (3 patients). After radiosurgery, 1 patient developed a temporary hemiparesis. Two permanent neurological deficits occurred after embolization before radiosurgery. No patient had an intracranial hemorrhage after treatment.Conclusion: Stereotactic radiosurgery provides effective long-term relief of symptoms in selected patients with DAVFs. (c) 2005 Elsevier Inc. All rights reserved.