Pollock B E, Garces Y I, Stafford S L, Foote R L, Schomberg P J, Link M J
Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Neurosurg. 2000 Dec;93(6):987-91. doi: 10.3171/jns.2000.93.6.0987.
The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years.
Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02).
It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.
立体定向放射外科治疗脑海绵状血管畸形（CMs）存在争议。为评估CM放射外科治疗的疗效和安全性，作者回顾了梅奥诊所过去10年的经验。
17例患者因手术风险高的CMs接受放射外科治疗，病变部位如下：丘脑/基底节（4例）、脑干（12例）和胼胝体（1例）。所有患者在接受放射外科治疗前至少有两次记录在案的出血。所有病例均采用立体定向磁共振（MR）成像进行靶点定位。中位边缘辐射剂量为18 Gy，中位最大剂量为32 Gy。放射外科治疗后的中位随访时间为51个月。放射外科治疗前51个月的年出血率为40.1%，而放射外科治疗后的前2年为8.8%，之后为2.9%。10例患者（59%）出现了新的神经功能缺损，与放射外科治疗后中位8个月（范围5 - 16个月）进行的长重复时间MR成像上信号增强区域相关。3例患者恢复，该组永久性放射相关发病率为41%。与同期接受放射外科治疗的31例大小和位置与上述CMs相似的动静脉畸形（AVM）患者相比，CMs患者更易出现放射相关并发症（任何并发症，59% 对比10%；p < 0.001；永久性并发症，41% 对比10%；p = 0.02）。
根据现有数据，无法得出放射外科能保护CMs患者预防未来出血风险的结论，尽管似乎在数年的潜伏期后出血率有所降低。治疗CMs的放射外科治疗后发生放射相关并发症的风险大于AVM放射外科治疗后的风险，即使对病变大小、位置和辐射剂量进行调整后也是如此。
