立体定向伽玛刀治疗脑动静脉畸型研究

目的评估伽玛刀(γ-刀)立体定向放射手术治疗脑动静脉畸形(AVM)的疗效;探讨脑AVM的γ-刀治疗定位方法。方法用立体定向Leksellγ-刀放射外科治疗系统对216例脑AVM进行γ-刀立体定向放射手术,并随访17～31个月。男性患者162例,女性54例,年龄1.5～83岁(Md=26),Spetzler Martin分级:I级42例,Ⅱ级68例,Ⅲ级95例,Ⅳ级7例及Ⅴ级4例。AVM体积0.3～43.9cm3(Md=7.1),放射手术周边剂量12～30Gy,平均(21.2±6.4)Gy。用1.5Tesla磁共振行磁共振血管造影(MRA)定位156例,数字减影血管造影(DSA)定位22例,MRA与DSA联合定位38例。结果γ-刀治疗后的AVM闭塞情况和并发症的发生与其体积、分级、定位方法、周边剂量、剂量规划及质量控制等因素有关。对体积≤5.0cm3或Spetzler Martin分级<Ⅲ级及周边剂量≥20Gy者,其2年闭塞率超过78.5%。本组有4例γ-刀放射手术后出血,9例并发有明显症状的放射性脑水肿。结论γ-刀高科技手术是治疗脑AVM的一种安全、有效的方法,特别是Spetzler MartinI-Ⅱ级或体积≤5.0cm3的AVM及周边剂量≥20Gy者疗效较好;DSA结合MRA联合定位对提高AVM的闭塞率、降低并发症有帮助。

Stereotactic gamma knife radiosurgery for brain arteriovenous malformations (A Report of 216 Cases)

Objective To evaluate the curative effect of stereotactic gamma knife radiosurgery on brain arteriovenous malformations (AVM).Methods Between July 1995 and May 1998,285 patients with cerebral AVM were treated with Leksell gamma knife,among which we collected the follow-up files of 216 cases fitting our demand,including 162 male and 54 female patients.The mean age of patients was 26.0 years (1.5～83 years).AVM volume ranged from 0.3 to 43.9 cm3 (the mean volume of Spetzler-Martin grading were as follows:grade I 42 cases,grade Ⅱ 68 cases,grade Ⅲ 95 cases,grade Ⅳ 7 cases,grade Ⅴ 4 cases.All the cases were followed up for 17～31 months.156 cases were oriented through conducting magnetic resonance angiography (MRA) with a 1.5 Tesla magnetic resonance system.Results The rates of obliteration and complications after stereotactic gamma knife radiosurgery were significantly related to the target volume,the Spetzlcr-Martin grade,the method of localization,the peripheral dosage and the quality control.The obliteration rate within two years was more than 78.5% in the patients with AVM≤5 cm3 in volume,Spetzler-Martin grade＜Ⅲ in Spetzler-Martin grading system or peripheral dosage≥20Gy.4 cases had recurrent hemorrhage after the treatment and 9 cases had complications of obvious symptom of irradiated brain edema.Conclusions Stereotactic gamma knife radiosurgery is an effective and safe method for the brain AVM.There is a higher obliteration rate for AVM of grade Ⅰ-Ⅱ or the volume≤5.0 cm3 and the peripheral dosage≥20Gy.Accurate localization of the lesions by magnetic resonance angiography (MRA) combined with digital subtraction angiography (DSA) contributes to improve the obliteration rate and decrease the complications.