Liscák R, Vladyka V, Simonová G, Vymazal J, Novotny J
Department of Stereotactic and Radiation Neurosurgery, Hospital Na Homolce, Prague, Czech Republic.
Minim Invasive Neurosurg. 2000 Dec;43(4):201-7. doi: 10.1055/s-2000-11378.
Over 6 years (1992-1998) 26 patients with brain stem cavernomas were treated using the Leksell gamma knife in Prague. 25 patients had a follow up of 6-66, median 24 months. Annual risk of bleeding before radiosurgery was 4%. After gamma knife treatment sudden impairment of neurodeficit reported as rebleeding was observed in 4 patients at 6-51 months, median 16.5 months, after radiosurgery. This represented a 6.8% risk of rebleeding after radiosurgery, which is not significantly different from the risk before radiosurgery. MRI or CT was performed in 24 patients 6-48, median 24, months after radiosurgery. There were no signs of rebleeding in any of the patients, nor any increase of the cavernoma. A decrease of cavernoma size was observed in 8 (33%) of patients. Temporary collateral edema after radiosurgery was detected in 5 (21%) of patients 3-12, median 11, months after radiosurgery. Neurodeficit was observed in 21 of 26 patients before radiosurgery. Improvement of the neurodeficit was detected in 9 (43%) of them 6-36, median 8, months after radiosurgery. Temporary morbidity caused by collateral edema or rebleeding occurred in 7 patients (28%) and permanent morbidity remained in 2 patients (8%). 2 patients died because of rebleeding 6 and 51 months after radiosurgery and the third patient for unrelated reason. Radiosurgery of the brain stem cavernomas was indicated when there was bleeding in the history or progressive neurodeficit and microsurgery was considered too risky. Leksell gamma knife radiosurgery of cavernomas has proved its low morbidity and zero mortality. In case of an insufficient effect of radiosurgery, or if the protective effect from rebleeding comes too late, morbidity and mortality can correspond to the natural course of the disease, as it was left without any treatment.
在6年期间（1992 - 1998年），布拉格使用Leksell伽玛刀治疗了26例脑干海绵状血管瘤患者。25例患者接受了6至66个月的随访，中位随访时间为24个月。放射外科手术前每年的出血风险为4%。伽玛刀治疗后，在放射外科手术后6至51个月，中位时间为16.5个月，有4例患者出现了被报告为再出血的神经功能突然受损。这代表放射外科手术后再出血的风险为6.8%，与放射外科手术前的风险无显著差异。在放射外科手术后6至48个月，中位时间为24个月，对24例患者进行了MRI或CT检查。所有患者均无再出血迹象，海绵状血管瘤也没有增大。8例（33%）患者的海绵状血管瘤体积减小。在放射外科手术后3至12个月，中位时间为11个月，5例（21%）患者检测到了暂时性的周围性水肿。放射外科手术前，26例患者中有21例存在神经功能缺损。放射外科手术后6至36个月，中位时间为8个月，其中9例（43%）患者的神经功能缺损得到改善。7例患者（28%）出现了由周围性水肿或再出血引起的暂时性并发症，2例患者（8%）仍存在永久性并发症。2例患者在放射外科手术后6个月和51个月因再出血死亡，第3例患者死于无关原因。当有出血史或进行性神经功能缺损且认为显微手术风险过高时，可考虑对脑干海绵状血管瘤进行放射外科治疗。Leksell伽玛刀放射外科治疗海绵状血管瘤已证明其低并发症率和零死亡率。如果放射外科手术效果不佳，或者预防再出血的保护作用出现过晚，并发症率和死亡率可能与疾病的自然病程相当，就如同未进行任何治疗一样。
