Department of Neurological Surgery and the Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Neurosurg Focus. 2010 Sep;29(3):E11. doi: 10.3171/2010.7.FOCUS10151.
The authors performed a retrospective review of prospectively collected data to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) for the treatment of patients harboring symptomatic solitary cavernous malformations (CMs) of the brainstem that bleed repeatedly and are high risk for resection.
Between 1988 and 2005, 68 patients (34 males and 34 females) with solitary, symptomatic CMs of the brainstem underwent Gamma Knife surgery. The mean patient age was 41.2 years, and all patients had suffered at least 2 symptomatic hemorrhages (range 2-12 events) before radiosurgery. Prior to SRS, 15 patients (22.1%) had undergone attempted resection. The mean volume of the malformation treated was 1.19 ml, and the mean prescribed marginal radiation dose was 16 Gy.
The mean follow-up period was 5.2 years (range 0.6-12.4 years). The pre-SRS annual hemorrhage rate was 32.38%, or 125 hemorrhages, excluding the first hemorrhage, over a total of 386 patient-years. Following SRS, 11 hemorrhages were observed within the first 2 years of follow-up (8.22% annual hemorrhage rate) and 3 hemorrhages were observed in the period after the first 2 years of follow-up (1.37% annual hemorrhage rate). A significant reduction (p < 0.0001) in the risk of brainstem CM hemorrhages was observed following radiosurgical treatment, as well as in latency period of 2 years after SRS (p < 0.0447). Eight patients (11.8%) experienced new neurological deficits as a result of adverse radiation effects following SRS.
The results of this study support a role for the use of SRS for symptomatic CMs of the brainstem, as it is relatively safe and appears to reduce rebleeding rates in this high-surgical-risk location.
作者对前瞻性收集的数据进行回顾性分析，以评估立体定向放射外科（SRS）治疗存在以下情况的患者的安全性和疗效：患有症状性孤立性脑干海绵状畸形（CM），且反复出血且手术风险高。
1988 年至 2005 年间，68 例（34 例男性，34 例女性）患有症状性孤立性脑干 CM 的患者接受了伽玛刀手术。患者平均年龄为 41.2 岁，且所有患者在放射外科治疗前至少经历了 2 次有症状的出血（范围为 2-12 次事件）。在 SRS 之前，15 例（22.1%）患者进行了尝试性切除。治疗的畸形平均体积为 1.19ml，平均处方边缘辐射剂量为 16Gy。
平均随访时间为 5.2 年（范围为 0.6-12.4 年）。SRS 前的年出血率为 32.38%，即 125 次出血（不包括首次出血），共 386 患者-年。SRS 后，前 2 年的随访期内发生了 11 次出血（8.22%的年出血率），在首次 2 年后的随访期内发生了 3 次出血（1.37%的年出血率）。放射外科治疗后以及 SRS 后 2 年潜伏期，脑干 CM 出血的风险显著降低（p<0.0001）（p<0.0447）。8 例患者（11.8%）由于 SRS 后的放射性不良反应出现新的神经功能缺损。
本研究结果支持对症状性脑干 CM 采用 SRS，因为它相对安全，并且似乎可以降低这个高手术风险部位的再出血率。
