Nataf F, Ghossoub M, Missir O, Beuvon F, Varlet P, Merienne L, Schlienger M, Roux F X
Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris Cedex 14, France.
Neurochirurgie. 2001 May;47(2-3 Pt 2):355-68.
Purposes of this study are to describe different parenchymal changes seen after radiosurgery of cerebral arteriovenous malformations and the clinical symptoms which can be associated, and risk factors correlated with them.
and method. From the whole population of 705 patients with a cerebral arteriovenous malformations treated by radiosurgery between 1984 and 1998, clinical from 615 patients and post radiosurgery MRI data from 367 patients were reviewed. Neurological deficit occurred in 5.37% of cases and was still persistant in 1.46% of cases. Delay of occurrence of deficits ranged from 6 to 83 months (mean: 27 months, median: 15 months). Parenchymal changes seen in MRI were classified in 4 grades: 1 without parenchymal changes, 2 hypersignal in sp T2, 3=2 with homogenous enhancement with gadolinium, 4 with hyposignal in spT1 and annular irregular enhancement. Several parameters (size, volume, angioarchitecture of the cerebral arteriovenous malformation, dosimetric parameters) were studied and correlations were searched by uni and multivariate analysis with occurrence and delay of occurrence of deficits or parenchymal changes.
In multivariate analysis, only size was significantly correlated with occurrence of parenchymal changes (p=0.0016); only size of the malformation was significantly correlated with delay of occurrence of parenchymal changes (p=0.0082); only grade 4 was correlated with occurrence of neurological deficit (p<0.00001). However, when only "a priori" parameters (known before radiosurgery) are introducted in logistic model, size taille (p=0.02) and hypoplasy of a sinus (p=0.0049) are significantly correlated with occurrence of neurological deficit. Only parenchymal changes grade 4 was significantly correlated with delay of occurrence of a neurological deficit (p<0.00001). However, when only a priori parameters (known before radiosurgery) are introducted in logistic model, only arterial steal (p=0.054) was significantly correlated with delay of occurrence of a neurological deficit.
Parenchymal changes are various in expression, signification and clinical symptoms associated with them. They must be known and recognized for better prevention and symptomatic treatment as well.
本研究旨在描述脑动静脉畸形放射外科治疗后所观察到的不同实质改变、与之相关的临床症状以及与之相关的危险因素。
回顾了1984年至1998年间接受放射外科治疗的705例脑动静脉畸形患者的全部资料，其中615例患者的临床资料以及367例患者放射外科治疗后的MRI数据。神经功能缺损发生率为5.37%，持续存在率为1.46%。缺损出现的延迟时间为6至83个月（平均：27个月，中位数：15个月）。MRI所见的实质改变分为4级：1级无实质改变；2级T2加权像高信号；3级=2级加钆增强均匀；4级T1加权像低信号且环形不规则增强。研究了几个参数（脑动静脉畸形的大小、体积、血管构筑、剂量学参数），并通过单因素和多因素分析寻找与缺损或实质改变的发生及发生延迟的相关性。
多因素分析中，仅大小与实质改变的发生显著相关（p = 0.0016）；仅畸形大小与实质改变的发生延迟显著相关（p = 0.0082）；仅4级与神经功能缺损的发生相关（p < 0.00001）。然而，当仅将“术前”参数（放射外科治疗前已知）引入逻辑模型时，大小（p = 0.02）和静脉窦发育不全（p = 0.0049）与神经功能缺损的发生显著相关。仅4级实质改变与神经功能缺损发生延迟显著相关（p < 0.00001）。然而，当仅将术前参数引入逻辑模型时，仅动脉盗血（p = 0.054）与神经功能缺损发生延迟显著相关。
实质改变在表现、意义及相关临床症状方面各不相同。为了更好地进行预防和对症治疗，必须了解和认识这些改变。
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