Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.
Neurosurgery. 2012 Jan;70(1):150-4; discussion 154. doi: 10.1227/NEU.0b013e31822c5740.
Despite a high success rate in the stereotactic radiosurgical treatment of intracranial arteriovenous malformations (AVMs) that cannot be safely resected with microsurgery, some patients must be managed after treatment failure.
To provide an update on the use of repeat linear accelerator radiosurgery as a treatment for failed AVM radiosurgery at the University of Florida.
We reviewed 103 patients who underwent repeat radiosurgical treatment for residual AVM at the University of Florida between December 1991 and December 2007. Each of these patients had at least 2 radiosurgical treatments for the same AVM. Patient information, including AVM nidus volume, prescription dose, age, and sex, was collected at the time of initial treatment and again at the time of retreatment. Patients were followed up after treatment with magnetic resonance, computed tomography, and angiographic imaging at standard intervals to determine the status of their AVM. The median follow-up after retreatment was 31 months.
Between the first and second treatments, the median AVM nidus volume was decreased by 69% (from a median volume of 12.7 to 4.0 cm), allowing the median prescribed dose to be increased from 1500 cGy on initial treatment to 1750 cGy on retreatment. The final obliteration rate on retreatment was 65.3%. After salvage retreatment, 5 patients (4.9%) experienced radiation-induced complications, and 6 patients (5.8%) experienced posttreatment hemorrhage.
Repeat radiosurgery is a safe and effective salvage treatment for AVMs.
尽管立体定向放射外科手术治疗不能用显微镜手术安全切除的颅内动静脉畸形（AVM）的成功率很高，但仍有部分患者在治疗失败后需要进行治疗。
提供佛罗里达大学使用重复线性加速器放射外科手术治疗失败的 AVM 放射外科手术的最新信息。
我们回顾了 1991 年 12 月至 2007 年 12 月期间在佛罗里达大学接受重复放射外科治疗的 103 例残余 AVM 患者。这些患者中，每个患者至少有 2 次针对同一 AVM 的放射外科治疗。在初始治疗和再次治疗时收集了患者的信息，包括 AVM 核心体积、处方剂量、年龄和性别。患者在治疗后进行磁共振、计算机断层扫描和血管造影成像随访，以确定 AVM 的状况。治疗后中位随访时间为 31 个月。
在首次和再次治疗之间，AVM 核心体积中位数减少了 69%（从 12.7cm 减少至 4.0cm），允许中位数处方剂量从初始治疗的 1500cGy 增加至再次治疗的 1750cGy。再次治疗的最终闭塞率为 65.3%。在抢救性治疗后，5 名患者（4.9%）发生放射性并发症，6 名患者（5.8%）发生治疗后出血。
重复放射外科手术是治疗 AVM 的一种安全有效的挽救治疗方法。
