旋转式伽玛刀治疗脑动静脉畸形

目的：评估旋转式伽玛刀对脑动静脉畸形的治疗效果及术后并发症。方法：1996年11月－2000年5月以旋转式伽玛刀治疗脑动静脉畸形。脑动静脉畸形平均直径23mm。脑动静脉畸形周边平均照射剂量19．2Gy(13-25Gy),中心平均照射剂量37．6Gy(32.5-50Gy）。结果：106例病人有完整的随访资料，平均随访18．4个月（5－44个月）。5例病人（4．2％）伽玛刀治疗后5－13个月发生再出血，无死亡。78例病人治疗后行CT或MR检查，19例（22％）出现放射性水肿，多发生在治疗后6－18个月，一般经类固醇激素治疗，数月可消退，无遗留永久并发症。68例病人随访超过1年，其中57例在治疗后1年行脑血管造影复查，24例（42％）畸形血管完全闭塞。27例随访超过2年，其中23例行脑血管造影检查，18例（78％）完全闭塞。结论：旋转式伽玛刀是一种新的可靠的立体定向治疗设备，对脑动静脉畸形具有较高的治愈率，治疗后并并发症少且极少出现永久性并发症。

Rotating Gamma System Radiosurgery for Cerebral Arteriovenous Malformations

Obsjective To evaluate the effectiveness and safety of OUR Rotating Gamma System radiosurgery for cerebral arteriovenous malformations. Methods 132 with cerebral arteriovenous malformations (AVMs) were treated using a new radiosurgical system, Rotating Gamma System, between November 1996 and May 2000. The average size of AVMs was 23 mm in diameter (range 6 to 69 mm). The mean dose delivered to the AVM margin was 19.2 Gy(range 13 to 25 Gy), and that delivered to the center of the AVMs was 37.6 Gy (range 32.5 to 50 Gy). Results 106 patients were followed up for an average 18.4 months (range 5 to 44 months). 5 patients (4.7%) experienced rebleeding which took place between 5 and 13 months after treatment, but none of them died from hemorrhage. No bleeding took place after complete angiographic obliteration. Neuroimaging studies showed radiationinduced edema in 19 patients (22%) out of the 87 patients. None of them had severe permanent neurological deficits. Of the 68 patients followed up more than one year, 57 patients underwent angiography at 1 year after treatment. The complete obliteration was demonstrated in 24 patients (42%) at 1 year. There was a statistically significant ( P <0.001)correlation between 1 year angiographic obliteration rate and AVM size. Of the 27 patients followed more than 2 years, 23 patients underwent angiography at 2 year after treatment. The complete obliteration was demonstrated in 18 patients (78%). There was no significant correlation between obliteration rate and AVM size at 2 years ( P >0 05).These results can be compared to results of treatment with other radiosurgical system. Conclusion OUR Rotating Gamma System is a new effective and reliable stereotactic radiosurgical equipment for cerebral arteriovenous malformation.;