Nicolato Antonio, Foroni Roberto, Seghedoni Andrea, Martines Valentina, Lupidi Francesco, Zampieri Piergiuseppe, Sandri Marco F, Ricci Umberto, Mazza Carlo, Beltramello Alberto, Gerosa Massimo, Bricolo Albino
Department of Neurosurgery, University Hospital, Piazzale Stefani 1, Verona, Italy.
Childs Nerv Syst. 2005 Apr;21(4):301-7; discussion 308. doi: 10.1007/s00381-004-1049-5. Epub 2005 Jan 15.
The authors report their experience of gamma knife radiosurgery (GKR) in a large series of pediatric cerebral arteriovenous malformations (cAVMs). The advantages, risks and failures of this approach are presented and discussed.
Gamma knife radiosurgery was performed on 63 children aged < or =16 years. Haemorrhage was the clinical onset in 50 out of 63 cases. The mean pre-GK cAVM volume was 3.8 cm(3). Fifty-eight out of 63 cAVMs were Spetzler-Martin grades I-III. Most lesions (47 out of 63) were in eloquent or deep-seated brain regions.
Gamma knife radiosurgery-related complications occurred in 2 out of 47 cases with an available follow-up (1 had transient and 1 permanent morbidity). No bleeding occurred during the latency period. In 39 children with >36-month follow-up, complete cAVM occlusion was angiographically documented in 31, with a 3- and 4-year actuarial obliteration rate of 72 and 77% respectively. High rates of complete obliteration and very low frequency of permanent morbidity with no bleeding during the latency period encourage widespread application of GKR in the treatment of pediatric cAVMs.
作者报告了他们在大量小儿脑动静脉畸形（cAVM）患者中进行伽玛刀放射外科治疗（GKR）的经验。介绍并讨论了这种治疗方法的优点、风险及失败情况。
对63例年龄小于或等于16岁的儿童进行了伽玛刀放射外科治疗。63例中有50例以出血为临床首发症状。GK治疗前cAVM的平均体积为3.8立方厘米。63例cAVM中有58例为Spetzler-Martin I-III级。大多数病变（63例中的47例）位于功能区或深部脑区。
在47例有随访资料的患者中，2例出现了与伽玛刀放射外科治疗相关的并发症（1例为短暂性并发症，1例为永久性并发症）。潜伏期内未发生出血。在39例随访超过36个月的儿童中，血管造影显示31例cAVM完全闭塞，3年和4年的实际闭塞率分别为72%和77%。高完全闭塞率、极低的永久性并发症发生率以及潜伏期内无出血情况，促使伽玛刀放射外科治疗在小儿cAVM治疗中得到广泛应用。
