旋转式伽玛刀治疗脑动静脉畸形254例

目的 评估旋转式伽玛刀对脑动静脉畸形(AVM)的治疗效果及术后并发症。方法 1996～2002年应用旋转式伽玛刀治疗脑AVM患者254例。AVM平均直径24mm，周边剂量平均17.7Gy，中心剂量平均35．6Gy。结果平均随访38．4个月(12～72个月)。9例患者(4．0％)伽玛刀治疗后5～21个月发生畸形血管破裂出血或再出血。225例患者治疗后行CT或MR检查，68例(30．2％)出现放射性水肿，其中6例(2．7％)遗留永久并发症。184例治疗后行脑血管造影或磁共振血管成像检查，治疗后1、2和3年的血管闭塞率分别为38．8％，71．2％和74．3％。结论旋转式伽玛刀是一种新的可靠的立体定向治疗设备，对AVM治疗后2—3年畸形血管完全闭塞率达70%以上，治疗后并发症少，且很少出现永久性并发症。

Rotating gamma system radiosurgery for cerebral arteriovenous malformations

Objective To evaluate the feasibility and complications of rotating gamma system radio-surgery for cerebral arteriovenous malformations (AVMs). Methods Two hundred and fifty four patients with AVMs were treated by a new radiosurgical system, Rotating Gamma System. The average size of AVMs was 24mm (6-69mm) in diameter. The dose delivered to the AVM margin was 17. 7Gy(13-26Gy), and 35. 6Gy(32. 5-52Gy) to the center. Results 225 patients were followed up for an average 38. 4 months (12-72 months) . Nine patients (4. 0% ) experienced bleeding or rebleeding which took place between 5 and 21 months after treatment, but none of them died from hemorrhage. No bleeding took place after complete angiographic obliteration. Neuroimaging studies showed radiation-induced edema in 68 patients (30. 2%) out of the 225 patients who had CT or MR scanning after treatment. New neurological deficit was found in fifteen, 9 of them were transient and 6 permanent. 184 patients underwent angiography or MRA after treatment. The complete obliteration was found in 38. 8% ,71. 2% and 74. 3% at 1, 2 and 3 years after treatment respectively. These results can be compared to the results of treatment with other radiosurgical system. Conclusion Rotating gamma system radiosurgery is a effective treatment for AVMs with a few complications.