Massager N, Régis J, Kondziolka D, Njee T, Levivier M
Gamma Knife Center, H pital Erasme, Brussels, Belgium.
J Neurosurg. 2000 Dec;93 Suppl 3:102-3. doi: 10.3171/jns.2000.93.supplement.
This study was undertaken to assess the efficacy and safety of gamma knife radiosurgery (GKS) for the treatment of arteriovenous malformations (AVMs) located within the brainstem.
The results of GKS performed in 87 patients with brainstem AVMs at two centers with experienced physicians are reviewed. The mean patient age was 37 years and the population included 19 children. The male/female ratio was 56:31. The malformation was located in the upper brainstem in 52 patients. Seventy-four percent of the patients had suffered a hemorrhage before GKS. For 70% of the patients no other treatment had been proposed before GKS. The mean AVM volume was 1.3 cm3. The lesions were treated with one to eight isocenters, with a margin dose ranging between 11.5 Gy and 30 Gy. The mean clinical follow-up period was 3.2 years. Ninety-five percent of the patients improved or remained neurologically stable. Rebleeding occurred in three patients at 3, 6, and 16 months, respectively, after GKS. Two patients in whom rebleeding occured recovered, and one died. The AVM obliteration rate was 63% at 2 years and 73% at 3 years after GKS. A second GKS was performed in six patients in whom only partial obliteration was demonstrated on angiography 3 years after the first procedure.
Gamma knife radiosurgery may be a valuable first-choice therapy for the treatment of AVMs located within the brainstem.
本研究旨在评估伽玛刀放射外科治疗（GKS）脑干动静脉畸形（AVM）的疗效和安全性。
回顾了在两个中心由经验丰富的医生对87例脑干AVM患者进行GKS的结果。患者平均年龄为37岁，其中包括19名儿童。男女比例为56:31。52例患者的畸形位于脑干上部。74%的患者在接受GKS之前曾发生过出血。70%的患者在接受GKS之前未接受过其他治疗。AVM平均体积为1.3立方厘米。病灶采用1至8个等中心进行治疗，边缘剂量在11.5 Gy至30 Gy之间。平均临床随访期为3.2年。95%的患者病情改善或神经功能保持稳定。3例患者分别在GKS后3个月、6个月和16个月发生再出血。发生再出血的2例患者康复，1例死亡。GKS后2年AVM闭塞率为63%，3年为73%。6例患者在首次手术后3年血管造影显示仅部分闭塞，因此进行了第二次GKS。
伽玛刀放射外科可能是治疗脑干AVM的一种有价值的首选治疗方法。
