Liscák Roman, Vladyka Vilibald, Simonová Gabriela, Urgosík Dusan, Novotný Josef, Janousková Ladislava, Vymazal Josef
Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
Neurosurgery. 2007 Jun;60(6):1005-14; discussion 1015-6. doi: 10.1227/01.NEU.0000255474.60505.4A.
Although relevant information exists regarding the chance of obliterating arteriovenous malformations (AVMs) using radiosurgery, the overall chance of cure after gamma knife radiosurgery is usually only extrapolated from a portion of all monitored patients. This chance and the risks involved in radiosurgery, including repeat treatment when necessary in a defined population of treated patients, were analyzed in our study.
Between October 1992 and June 2000, gamma knife radiosurgery was performed on 330 patients with AVMs. The volume of the AVM nidus ranged from 0.15 to 28.6 cm (median, 3.9 cm). When complete obliteration was not achieved within 3 years, repeat radiosurgery was performed on 76 patients. The volume of the nidus for the second treatment ranged from 0.09 to 16.8 cm (median 2.9 cm). The result was reviewed in 300 (91%) patients after the first round of treatment and in 68 (89.5%) after the second round of treatment.
AVM obliteration was achieved in 222 (74%) patients after the first round of radiosurgery and in 47 (69%) after the second. The overall chance of cure was 92% (269 patients). Final angiography verified complete obliteration by 12 to 96 months (median, 25 mo) after initial radiosurgery. Smaller volume AVMs and the application of a higher radiation dose resulted in a higher chance of obliteration. The risk of rebleeding after radiosurgery was 2.1% annually until full obliteration, and the overall mortality from rebleeding was 1%. The risk of permanent morbidity after the first and second radiosurgery treatments were 2.7 and 2.9%, respectively. The cumulative risk of morbidity in both groups of patients was 3.4%.
Although one-quarter of the patients required that the treatment be repeated, gamma knife radiosurgery can offer a high cure rate for patients treated for AVMs with a low risk of morbidity and mortality from rebleeding during the latent period.
尽管存在关于使用放射外科手术消除动静脉畸形（AVM）可能性的相关信息，但伽玛刀放射外科手术后的总体治愈几率通常仅从所有接受监测患者的一部分中推断得出。在我们的研究中，分析了这种几率以及放射外科手术所涉及的风险，包括在特定治疗患者群体中必要时进行重复治疗的情况。
1992年10月至2000年6月期间，对330例AVM患者进行了伽玛刀放射外科手术。AVM病灶体积为0.15至28.6立方厘米（中位数为3.9立方厘米）。若3年内未实现完全闭塞，则对76例患者进行重复放射外科手术。第二次治疗的病灶体积为0.09至16.8立方厘米（中位数为2.9立方厘米）。第一轮治疗后对300例（91%）患者的结果进行了复查，第二轮治疗后对68例（89.5%）患者进行了复查。
第一轮放射外科手术后，222例（74%）患者的AVM实现了闭塞，第二轮手术后为47例（69%）。总体治愈几率为92%（269例患者）。最终血管造影证实，初始放射外科手术后12至96个月（中位数为25个月）实现了完全闭塞。较小体积的AVM以及应用更高的辐射剂量导致闭塞几率更高。放射外科手术后每年再出血风险为2.1%，直至完全闭塞，再出血导致的总体死亡率为1%。第一次和第二次放射外科治疗后永久性致残风险分别为2.7%和2.9%。两组患者的累积致残风险为3.4%。
尽管四分之一的患者需要重复治疗，但伽玛刀放射外科手术可为接受AVM治疗的患者提供高治愈率，且在潜伏期再出血导致的致残和死亡风险较低。
