伽玛刀治疗颅内海绵状血管畸形

目的评估伽玛刀治疗海绵状血管畸形的疗效.方法回顾性分析了1994～2001年在我院接受伽玛刀治疗并获随诊的92例海绵状血管畸形病例,共114个病灶的影像学特点、伽玛刀治疗效果及副作用.并对6例(本组1例及外院5例)放射外科治疗后不同时期的手术病理标本加以分析.结果在以控制癫痫为主的43例患者中,36例(83.7%)癫痫发作减轻,其中12例(27.9%)癫痫发作消失.在所有92例患者中,有影像学证实的症状性再出血9例(9.8%),其中1例死亡;灶周水肿导致一过性症状加重者7例(7.6%),其中1例实施开颅手术.症状性水肿发生在治疗后6～16个月,与灶周正常脑组织受线剂量有关.放射外科治疗后海绵状血管畸形的主要病理改变为凝固性坏死,不断的血栓机化使畸形管腔逐渐闭锁.结论伽玛刀治疗小型及手术高风险区域的海绵状血管畸形是可行的.出血急性期和/或病情进展期实施伽玛刀治疗要慎重,掌握好治疗时机及病灶影像学特征可以大大降低治疗相关副作用.放射外科可有效缓解癫痫发作,也可以在治疗数年后减少再出血发生.

Gamma knife radiosurgery for cavernous malformations

OBJECTIVE: To evaluate the efficacy of Gamma knife surgery (GKS) in treating cavernous malformation (CM). METHODS: From 1994 to 2001, 92 patients with 114 CMs were treated by GKS and then followed up for 2-8 years (mean 4.1+/-1.9). We analyzed the MRI features of CMs bleeding, efficacy of GKS, and the complications of treatment. Six pathological specimens after radiosurgery (1 from our group, 5 from other centers) were also assayed. RESULTS: Among 43 patients who were treated by GKS to control their epilepsy, epileptic paroxysm was alleviated in 36 patients (83.7%), including 12 (27.9%) seizure-free. Rebleeding was confirmed in 9 patients (9.8%) by neuroimage, one of whom died. Transient symptomatic radiation edema occurred in 7 cases (7.6%) within 6-12 months after radiosurgery, and one patient underwent open surgery for cerebral decompression. The main pathological changes of cavernoma were coagulation necrosis and the vessels obliterated gradually after radiosurgery. CONCLUSIONS: It is feasible to treat small and surgically high risk CMs by radiosurgery. The treatment has to be prudent in an acute bleeding and symptomatic progression. Optimal treatment timing and dose planning are prerequisites to reduce radiation-related complications. GKS is safe and effective to control the epilepsy caused by CMs, and also to bring down the rebleeding rate after a latency interval of several years.