The National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Neurosurgery. 2012 Jun;70(6):1458-69; discussion 1469-71. doi: 10.1227/NEU.0b013e318246a4d0.
Radiosurgery is widely used to treat deep eloquent arteriovenous malformations (AVMs).
To evaluate how anatomic location, AVM size, and treatment parameters define outcome.
Retrospective analysis of 356 thalamic/basal ganglia and 160 brainstem AVMs treated with gamma knife radiosurgery.
Median volume was 2 cm (range, 0.02-50) for supratentorial and 0.5 cm (range, 0.01-40) for brainstem AVMs; the marginal treatment doses were 17.5 to 25 Gy. After single treatment, obliteration was achieved in 65% of the brainstem, in 69% of the supratentorial, and 40% of the peritectal AVMs. Obliteration of lesions <4 cm was better in the brainstem (70%) and in the supratentorium (80%), but not in the peritectal region (40%). Complications were rare (6%-15%) and mild (≤ modified Rankin scale [MRS] 2). Rebleed rate increased with size, but was not higher than before treatment. AVMs >4 cm in the brainstem were treated with unacceptable morbidity and low cure rate. Obliteration of large supratentorial AVMs was 65% to 47% with more complications ≥ MRS3. Repeat radiosurgical treatment led to obliteration in 66% of the cases with minor morbidity.
Deep eloquent AVMs <4 cm can be treated safely and effectively with radiosurgery. Obliteration of peritectal AVMs is significantly lower after a single treatment. However, morbidity is low, and repeat treatment leads to good obliteration. Radiosurgical treatment >4 cm in the brainstem is not recommended. Supratentorial deep AVMs >8 cm can be treated with radiosurgery with higher risk and lower obliteration rate. However, these lesions are difficult to treat with other treatment modalities, and a 50% success rate makes radiosurgery a good alternative even in this challenging group.
放射外科广泛用于治疗深部语言区动静脉畸形（AVM）。
评估解剖位置、AVM 大小和治疗参数如何定义治疗结果。
回顾性分析 356 例丘脑/基底节区和 160 例脑干 AVM 患者，均采用伽玛刀放射外科治疗。
幕上 AVM 容积中位数为 2cm（范围 0.02-50），脑干 AVM 容积中位数为 0.5cm（范围 0.01-40）；边缘治疗剂量为 17.5-25Gy。单次治疗后，脑干 AVM 闭塞率为 65%，幕上 AVM 闭塞率为 69%，脑室周围 AVM 闭塞率为 40%。<4cm 的病变在脑干（70%）和幕上（80%）的闭塞率较好，但脑室周围区域（40%）的闭塞率没有提高。并发症罕见（6%-15%）且轻微（≤改良 Rankin 量表 [MRS] 2 级）。随着体积的增加，再出血率增加，但不比治疗前高。脑干>4cm 的 AVM 治疗后发病率高，治愈率低。>4cm 的幕上巨大 AVM 治疗后，并发症≥MRS3 的比例为 65%-47%。再次放射外科治疗后，66%的病例闭塞，且发病率较低。
<4cm 的深部语言区 AVM 可安全有效地采用放射外科治疗。单次治疗后，脑室周围 AVM 的闭塞率显著降低。然而，发病率较低，且重复治疗可获得较好的闭塞率。不推荐对脑干>4cm 的 AVM 进行放射外科治疗。>8cm 的幕上深部 AVM 可采用放射外科治疗，但风险较高，闭塞率较低。然而，这些病变采用其他治疗方法难以治疗，50%的成功率使放射外科成为即使在这一挑战性患者群体中也是一种较好的选择。
