Stereotactic radiosurgery for arteriovenous malformations, Part 4: management of basal ganglia and thalamus arteriovenous malformations Clinical article
Stereotactic radiosurgery for arteriovenous malformations, Part 4: management of basal ganglia and thalamus arteriovenous malformations Clinical article
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DOI：
10.3171/2011.9.jns11175
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发表时间：
2012-01-01
影响因子：
4.1
通讯作者：
Lunsford, L. Dade
中科院分区：
文献类型：
--
作者：
Kano, Hideyuki;Kondziolka, Douglas;Lunsford, L. Dade
Object.作者进行了一项研究，以确定立体定向放射外科手术（SRS）治疗基底节和丘脑动静脉畸形（AVM）的长期结局和风险。在1987年至2006年期间，作者对996例脑AVM患者进行了伽玛刀手术; 56例患者患有基底节AVM，77例患者患有丘脑AVM。在该系列中，133例患者中有113例（85%）既往出血。中位靶区体积为2.7 cm 3（范围0.1-20.7 cm 3），中位边缘剂量为20戈伊（范围15-25戈伊）。在中位随访期61个月（范围2-265个月）内，78例患者的MR成像和63例患者的血管造影最终记录了AVM闭塞。放射外科手术后3、4、5和10年的完全闭塞率分别为57%、70%、72%和72%。与AVM闭塞率较高相关的因素包括位于基底节的AVM、较小的靶体积、较小的最大直径和较高的边缘剂量。133例患者中有15例（11%）在潜伏期发生出血，7例患者死亡。1、2、3、5和10年时SRS后AVM出血率分别为4.5%、6.2%、9.0%、11.2%和15.4%。总体年出血率为4.7%。当从本分析中删除SRS后6个月内发生7次出血的5名患者时，年出血率下降至2.7%。SRS后，体积较大的AVM出血风险较高。6名患者（4.5%）因不良辐射效应（战神）出现永久性神经功能缺损，1名患者在SRS后56个月出现迟发性囊肿。无患者死于战神。与症状性战神风险较高相关的因素是靶体积较大、最大直径较大、边缘剂量较低和Pollock-Flickinger评分较高。立体定向放射外科是治疗基底节和丘脑深部AVM的一种逐渐有效且相对安全的治疗选择。虽然在本系列中没有发生闭塞后出血，但在SRS和闭塞之间的潜伏期内，患者仍有风险。SRS的最佳候选者是基底神经节内体积较小的AVM患者。(DOI：10.3171/2011.9.JNS11175）
Object. The authors conducted a study to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the basal ganglia and thalamus.Methods. Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 56 patients had AVMs of the basal ganglia and 77 had AVMs of the thalamus. In this series, 113 (85%) of 133 patients had a prior hemorrhage. The median target volume was 2.7 cm(3) (range 0.1-20.7 cm(3)) and the median margin dose was 20 Gy (range 15-25 Gy).Results. Obliteration of the AVM eventually was documented on MR imaging in 78 patients and on angiography in 63 patients in a median follow-up period of 61 months (range 2-265 months). The actuarial rates documenting total obliteration after radiosurgery were 57%, 70%, 72%, and 72% at 3, 4, 5, and 10 years, respectively. Factors associated with a higher rate of AVM obliteration included AVMs located in the basal ganglia, a smaller target volume, a smaller maximum diameter, and a higher margin dose. Fifteen (11%) of 133 patients suffered a hemorrhage during the latency period and 7 patients died. The rate of post-SRS AVM hemorrhage was 4.5%, 6.2%, 9.0%, 11.2%, and 15.4% at 1, 2, 3, 5, and 10 years, respectively. The overall annual hemorrhage rate was 4.7%. When 5 patients with 7 hemorrhages occurring earlier than 6 months after SRS were removed from this analysis, the annual hemorrhage rate decreased to 2.7%. Larger volume AVMs had a higher risk of hemorrhage after SRS. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 6 patients (4.5%), and in 1 patient a delayed cyst developed 56 months after SRS. No patient died of AREs. Factors associated with a higher risk of symptomatic AREs were larger target volume, larger maximum diameter, lower margin dose, and a higher Pollock-Flickinger score.Conclusions. Stereotactic radiosurgery is a gradually effective and relatively safe management option for deep-seated AVMs in the basal ganglia and thalamus. Although hemorrhage after obliteration did not occur in the present series, patients remain at risk during the latency interval between SRS and obliteration. The best candidates for SRS are patients with smaller volume AVMs located in the basal ganglia. (DOI: 10.3171/2011.9.JNS11175)