Pollock Bruce E, Gorman Deborah A, Coffey Robert J
Department of Neurologic Surgery, Division of Radiation Oncology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Neurosurgery. 2003 Jun;52(6):1291-6; discussion 1296-7. doi: 10.1227/01.neu.0000064800.26214.fe.
Radiosurgery is commonly performed for patients with small to medium-sized arteriovenous malformations (AVMs). However, few articles present overall outcomes after one or more radiosurgical procedures, and few data are available for periods longer than 5 years after AVM radiosurgery.
Between 1990 and 1997, 144 patients underwent AVM radiosurgery and had angiographic follow-up. Of these patients, 112 (78%) had Spetzler-Martin Grade III or greater AVMs; 37 (26%) were located in the basal ganglia, thalamus, or brainstem. Twenty-six patients (18%) underwent repeat radiosurgery. The mean follow-up of 15 patients who died as a result of AVM bleeding or underwent AVM resection after the initial radiosurgery was 22 months (range, 3-47 mo); the mean follow-up of the remaining 129 patients was 86 months (range, 23-169 mo).
Excellent (obliteration without deficit, n = 96) or good (obliteration with minor deficit, n = 9) outcomes were achieved in 73% of patients after one or more radiosurgical procedures. Twenty patients (14%) sustained major deficits (n = 15; five had obliteration) or died (n = 5) after radiosurgery. Sixteen patients (11%) had unchanged neurological examinations but persistent arteriovenous shunting. Five patients (4%) required surgery (cystoperitoneal shunting, n = 1; AVM resection, n = 4) at a median of 65 months after radiosurgery because of symptomatic cyst formation or persistent edema. The radiosurgery AVM score correlated with both excellent (R(2) = -0.93, P = 0.003) and excellent or good (R(2) = -0.92, P = 0.004) outcomes.
The majority of AVM patients are protected from the risk of future hemorrhage and continue their normal daily activities after radiosurgery. Late complications requiring treatment are rare but can occur many years after patients are considered cured of their AVMs. Overall outcomes after AVM radiosurgery seem to be predicted accurately by the described method.
放射外科手术常用于治疗中小型动静脉畸形（AVM）患者。然而，很少有文章报道一次或多次放射外科手术后的总体结果，且关于AVM放射外科手术后超过5年的数据也很少。
1990年至1997年间，144例患者接受了AVM放射外科手术并进行了血管造影随访。其中，112例（78%）为Spetzler-Martin III级或更高级别的AVM；37例（26%）位于基底节、丘脑或脑干。26例患者（18%）接受了重复放射外科手术。15例因AVM出血死亡或在初次放射外科手术后接受AVM切除的患者的平均随访时间为22个月（范围3 - 47个月）；其余129例患者的平均随访时间为86个月（范围23 - 169个月）。
在一次或多次放射外科手术后，73%的患者获得了优异（无功能缺损且畸形闭塞，n = 96）或良好（有轻微功能缺损且畸形闭塞，n = 9）的结果。20例患者（14%）在放射外科手术后出现严重功能缺损（n = 15；其中5例畸形闭塞）或死亡（n = 5）。16例患者（11%）神经学检查无变化但动静脉分流持续存在。5例患者（4%）在放射外科手术后中位时间65个月时因出现症状性囊肿形成或持续性水肿而需要手术（囊肿 - 腹腔分流，n = 1；AVM切除，n = 4）。放射外科AVM评分与优异结果（R² = -0.93，P = 0.003）以及优异或良好结果（R² = -0.92，P = 0.004）均相关。
大多数AVM患者在放射外科手术后可免受未来出血风险，并能继续正常的日常活动。需要治疗的晚期并发症很少见，但可能在患者被认为AVM已治愈多年后发生。AVM放射外科手术后的总体结果似乎可以通过所描述的方法准确预测。
