Stereotactic radiosurgery for arteriovenous malformations, Part 1: management of Spetzler-Martin Grade I and II arteriovenous malformations Clinical article
Stereotactic radiosurgery for arteriovenous malformations, Part 1: management of Spetzler-Martin Grade I and II arteriovenous malformations Clinical article
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DOI：
10.3171/2011.9.jns101740
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发表时间：
2012-01-01
影响因子：
4.1
通讯作者：
Kondziolka, Douglas
中科院分区：
文献类型：
--
作者：
Kano, Hideyuki;Lunsford, L. Dade;Kondziolka, Douglas
Object.本文的目的是确定立体定向放射外科手术（SRS）治疗Spetzler-Martin I级和II级动静脉畸形（AVM）的结局和风险。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，包括217例Spetzler-Martin I级或II级AVM患者。中位最大直径和靶体积分别为1.9 cm（范围0.5-3.8 cm）和2.3 cm（范围0.1-14.1 cm（3））。中位边缘剂量为22戈伊（范围15-27戈伊）。148例患者通过MR成像和100例患者通过血管造影证实了动静脉畸形闭塞，中位随访时间为64个月（范围6-247个月）。在1次SRS手术后，通过血管造影或MR成像确定的3、4、5和10年时的完全闭塞率分别为58%、87%、90%和93%。到MR成像确定的完全闭塞的中位时间为30个月。与较高AVM闭塞率相关的因素是较小的AVM靶体积、较小的最大直径和较大的边缘剂量。13例（6%）患者在潜伏期内发生了并发症，6例患者死亡。SRS后1、2、3、5和10年AVM出血的累积发生率分别为3.7%、4.2%、4.2%、5.0%和6.1%。这对应于SRS后第0-1年、1-5年和5-10年的年出血风险率分别为3.7%、0.3%和0.2%。AVM近端共存动脉瘤的存在与显著更高的出血风险相关。5例患者（2.3%）在SRS后出现暂时性症状性放射不良反应，2例患者（1%）出现迟发性囊肿。对于体积较小、拒绝初次切除的Spetzler-Martin I级或II级AVM患者来说，立体定向放射外科手术是一种逐渐有效且相对安全的选择。在该系列中没有发生闭塞后出血。患者在潜伏期内仍有出血事件的风险，直至闭塞发生。患有动脉瘤和AVM的患者需要更积极的手术或血管内治疗，以降低SRS后潜伏期内出血的风险。(DOI：10.3171/2011.9.JNS101740）
Object. The aim of this paper was to define the outcomes and risks of stereotactic radiosurgery (SRS) for Spetzler-Martin Grade I and II arteriovenous malformations (AVMs).Methods. Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs, including 217 patients with AVMs classified as Spetzler-Martin Grade I or II. The median maximum diameter and target volumes were 1.9 cm (range 0.5-3.8 cm) and 2.3 cm(3) (range 0.1-14.1 cm(3)), respectively. The median margin dose was 22 Gy (range 15-27 Gy).Results. Arteriovenous malformation obliteration was confirmed by MR imaging in 148 patients and by angiography in 100 patients with a median follow-up of 64 months (range 6-247 months). The actuarial rates of total obliteration determined by angiography or MR imaging after 1 SRS procedure were 58%, 87%, 90%, and 93% at 3, 4, 5, and 10 years, respectively. The median time to complete MR imaging-determined obliteration was 30 months. Factors associated with higher AVM obliteration rates were smaller AVM target volume, smaller maximum diameter, and greater marginal dose. Thirteen patients (6%) suffered hemorrhages during the latency period, and 6 patients died. Cumulative rates of AVM hemorrhage 1, 2, 3, 5, and 10 years after SRS were 3.7%, 4.2%, 4.2%, 5.0%, and 6.1%, respectively. This corresponded to rates of annual bleeding risk of 3.7%, 0.3%, and 0.2% for Years 0-1, 1-5, and 5-10, respectively, after SRS. The presence of a coexisting aneurysm proximal to the AVM correlated with a significantly higher hemorrhage risk. Temporary symptomatic adverse radiation effects developed in 5 patients (2.3%) after SRS, and 2 patients (1%) developed delayed cysts.Conclusions. Stereotactic radiosurgery is a gradually effective and relatively safe option for patients with smaller volume Spetzler-Martin Grade I or II AVMs who decline initial resection. Hemorrhage after obliteration did not occur in this series. Patients remain at risk for a bleeding event during the latency interval until obliteration occurs. Patients with aneurysms and an AVM warrant more aggressive surgical or endovascular treatment to reduce the risk of a hemorrhage in the latency period after SRS. (DOI: 10.3171/2011.9.JNS101740)