Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Int J Radiat Oncol Biol Phys. 2011 Jun 1;80(2):354-61. doi: 10.1016/j.ijrobp.2010.01.049. Epub 2010 Apr 17.
This study examined the single-center treatment outcomes of arteriovenous malformations (AVMs) of the brain using stereotactic radiosurgery, with regard to obliteration, predictive factors, morbidities, and patient performance status.
127 patients were treated between 1990 and 2008 by use of linear accelerator or Gamma Knife. Their median age was 37 years, the median AVM volume was 7.3 cc (range, 0.014-113.13 cc), and the median follow-up duration was 42 months (range, 6-209 months). Forty-two percent of patients presented with intracranial hemorrhage, 31% received embolization, and 8% underwent prior resection. Thirty-one percent of patients received more than one round of radiosurgery.
64% of patients had complete obliteration confirmed by magnetic resonance imaging or angiography. Positive predictors of obliteration included pretreatment hemorrhage (p = 0.042), smaller AVM volume (odds ratio = 1.25; 95% CI, 1.03-1.52), and larger marginal dose (odds ratio = 0.292; 95% CI, 0.100-0.820), whereas embolization (p < 0.001) was a negative predictor . The annual risk of hemorrhage after radiosurgery was 2.2%, and the risk of death as a result of hemorrhage was 0.6-1.3%. Eleven percent of patients reported new or worsened neurologic symptoms. Radiosurgery was effective in treating AVM-related headaches (p < 0.001) but did not improve the performance status of patients.
Stereotactic radiosurgery is an effective tool in the treatment of AVMs and amelioration of AVM-related headaches, but it did not affect the patients' performance status. Factors affecting obliteration include prior hemorrhage, marginal dose, prior embolization, and AVM volume. Risk of hemorrhage persists in the latency period after radiosurgery, and it remains finite even after complete obliteration.
本研究通过立体定向放射外科治疗脑动静脉畸形（AVM），分析其闭塞率、预测因素、并发症和患者的体能状态。
1990 年至 2008 年，127 例患者采用直线加速器或伽玛刀治疗。患者中位年龄为 37 岁，AVM 体积中位数为 7.3cc（范围 0.014-113.13cc），中位随访时间为 42 个月（范围 6-209 个月）。42%的患者有颅内出血病史，31%的患者接受过血管内栓塞治疗，8%的患者接受过手术切除。31%的患者接受了 1 次以上的放射外科治疗。
64%的患者通过磁共振成像或血管造影证实完全闭塞。闭塞的预测因素包括治疗前出血（p=0.042）、较小的 AVM 体积（优势比=1.25；95%可信区间，1.03-1.52）和较大的边缘剂量（优势比=0.292；95%可信区间，0.100-0.820），而栓塞（p<0.001）是负相关因素。放射外科治疗后每年出血风险为 2.2%，因出血导致死亡的风险为 0.6-1.3%。11%的患者报告有新发或恶化的神经症状。放射外科治疗对 AVM 相关头痛有效（p<0.001），但不能改善患者的体能状态。
立体定向放射外科是治疗 AVM 和改善 AVM 相关头痛的有效工具，但不能改善患者的体能状态。影响闭塞的因素包括既往出血、边缘剂量、既往栓塞和 AVM 体积。放射外科治疗后仍存在迟发性出血风险，即使 AVM 完全闭塞，风险仍然存在。
