Huang Yin-Cheng, Tseng Chen-Kan, Chang Cheng-Nen, Wei Kuo-Cheng, Liao Cheng-Chih, Hsu Peng-Wei
Department of Neurosurgery, Chang Gung Memorial Hospital, No 5, Fu-shin St, Kweishan, Tauoyuan, Taiwan.
Clin Neurol Neurosurg. 2006 Dec;108(8):750-6. doi: 10.1016/j.clineuro.2006.04.001. Epub 2006 May 15.
The annual hemorrhage rate of intracranial cavernous malformation (CM) is reported to range from 0.23% to 1.1%. Because of the low hemorrhage rate, operating on a deep symptomatic lesion with or without hemorrhage is considered controversial. For the prevention of hemorrhage, radiosurgery is an alternative method, targeting smaller lesions and delivering higher doses of radiation. Linear accelerator (LINAC) radiosurgery, aside from the gamma knife (GK), is not often discussed in the treatment of CM.
From 1995 to 2005, 30 patients presenting with hemorrhage or seizures, aged 14-79 years (mean 24.0 years) with single (27 patients) or multiple (three patients) CMs received LINAC radiosurgery at our institute. Six patients received LINAC radiosurgery following craniotomy for residual lesions revealed by the follow-up MRI. The temporal lobe was the most common site for CM in this series (n=8), followed by the brain stem (n=7). Thirty patients received 34 radiosurgery treatments with peripheral doses ranging from 800 cGy to 2200 cGy. The mean follow-up time was 59.9 months (range 1-122 months).
One patient re-bled post-radiosurgery (0.67% in 149.75 observation-years). Two patients had asymptomatic post-LINAC edema (6.7%). Those three patients were symptom-free during the follow-up period.
We suggest that LINAC radiosurgery is a relatively safe technique for treating deep or residual CM, although the actual effectiveness for CM obliteration is not known.
据报道，颅内海绵状血管畸形（CM）的年出血率在0.23%至1.1%之间。由于出血率较低，对有或无出血的深部症状性病变进行手术被认为存在争议。为预防出血，放射外科是一种替代方法，其针对较小的病变并给予更高剂量的辐射。除伽玛刀（GK）外，直线加速器（LINAC）放射外科在CM治疗中并不常被讨论。
1995年至2005年，30例出现出血或癫痫发作的患者，年龄在14 - 79岁（平均24.0岁），患有单发（27例）或多发（3例）CM，在我院接受了LINAC放射外科治疗。6例患者在开颅术后因随访MRI显示有残留病变而接受了LINAC放射外科治疗。颞叶是本系列中CM最常见的部位（n = 8），其次是脑干（n = 7）。30例患者接受了34次放射外科治疗，周边剂量范围为800 cGy至2200 cGy。平均随访时间为59.9个月（范围1 - 122个月）。
1例患者在放射外科治疗后再次出血（149.75观察年中的发生率为0.67%）。2例患者出现无症状的LINAC术后水肿（6.7%）。这3例患者在随访期间均无症状。
我们认为，LINAC放射外科是治疗深部或残留CM的一种相对安全的技术，尽管其对CM闭塞的实际效果尚不清楚。
