Yomo Shoji, Hayashi Motohiro
Saitama Gamma Knife Centre, San-ai Hospital, Saitama, Japan.
Brain Nerve. 2011 Jan;63(1):41-9.
Cavernous malformations (CMs) consist of dilated vascular channels that have a characteristic appearance on MRI. They can present with seizures, neurological deficits due to lesion hemorrhage, or as incidental findings on neuroradiological studies. Treatment options include conservative therapy; medical management of seizures; surgical intervention; and in selected cases, stereotactic radiosurgery. The role of radiosurgery in the treatment of CMs remains controversial, in part, because of the absence of neuroimaging criteria to gauge their successful obliteration as well as its higher complication rates. Radiosurgery is recommended only for symptomatic lesions that are surgically inaccessible or located in eloquent brain. We reviewed previously published papers on CMs with respect to hemorrhage rates, seizure control, and radiation-induced morbidity in order to better understand the balance of benefits and risks associated with the radiosurgical treatment for CMs. The data in this review provides convincing evidence that stereotactic radiosurgery is a relatively safe procedure with acceptable risks of morbidity and that its use could reduce the rebleeding rate and the frequency of seizures caused by for CMs located in the high-surgical-risk regions of the brain. We also present our experience of treating for 16 patients with CMs and show that our results were comparable to those previously reported.
海绵状血管畸形(CMs)由扩张的血管通道组成,在磁共振成像(MRI)上具有特征性表现。它们可表现为癫痫发作、因病变出血导致的神经功能缺损,或作为神经放射学检查中的偶然发现。治疗选择包括保守治疗;癫痫的药物管理;手术干预;以及在特定情况下的立体定向放射外科治疗。放射外科在CMs治疗中的作用仍存在争议,部分原因是缺乏评估其成功闭塞的神经影像学标准以及较高的并发症发生率。仅推荐对手术难以到达或位于脑功能区的有症状病变进行放射外科治疗。我们回顾了先前发表的关于CMs出血率、癫痫控制和放射诱发并发症的论文,以便更好地理解与CMs放射外科治疗相关的利弊平衡。本综述中的数据提供了令人信服的证据,表明立体定向放射外科是一种相对安全的手术,具有可接受的并发症风险,并且其应用可以降低位于脑高手术风险区域的CMs的再出血率和癫痫发作频率。我们还展示了治疗16例CMs患者的经验,并表明我们的结果与先前报道的结果相当。