Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.
J Neurosurg. 2012 Apr;116(4):899-908. doi: 10.3171/2011.12.JNS11542. Epub 2012 Jan 20.
Gamma Knife surgery (GKS) has emerged as the treatment of choice for small- to medium-sized cerebral arteriovenous malformations (AVMs) in deep locations. The present study aims to investigate the outcomes of GKS for AVMs in the basal ganglia and thalamus.
Between 1989 and 2007, 85 patients with AVMs in the basal ganglia and 97 in the thalamus underwent GKS and were followed up for more than 2 years. The nidus volumes ranged from 0.1 to 29.4 cm(3) (mean 3.4 cm(3)). The mean margin dose at the initial GKS was 21.3 Gy (range 10-28 Gy). Thirty-six patients underwent repeat GKS for residual AVMs at a median 4 years after initial GKS. The mean margin dose at repeat GKS was 21.1 Gy (range 7.5-27 Gy).
Following a single GKS, total obliteration of the nidus was confirmed on angiograms in 91 patients (50%). In 12 patients (6.6%) a subtotal obliteration was achieved. No flow voids were observed on MR imaging in 14 patients (7.7%). Following single or repeat GKS, total obliteration was angiographically confirmed in 106 patients (58.2%) and subtotal obliteration in 8 patients (4.4%). No flow voids on MR imaging were observed in 18 patients (9.9%). The overall obliteration rates following one or multiple GKSs based on MR imaging or angiography was 68%. A small nidus volume, high margin dose, low number of isocenters, and no history of embolization were significantly associated with an increased rate of obliteration. Twenty-one patients experienced 25 episodes of hemorrhage in 850 risk-years following GKS, yielding an annual hemorrhage rate of 2.9%. Four patients died in this series: 2 due to complications of hemorrhage and 2 due to unrelated diseases. Permanent neurological deficits caused by radiation were noted in 9 patients (4.9%).
Gamma Knife surgery offers a reasonable chance of obliterating basal ganglia and thalamic AVMs and does so with a low risk of complications. It is an optimal treatment option in patients for whom the anticipated risk of microsurgery is too high.
伽玛刀手术（GKS）已成为治疗深部中小型脑动静脉畸形（AVM）的首选方法。本研究旨在探讨 GKS 治疗基底节和丘脑 AVM 的结果。
1989 年至 2007 年间，85 例基底节 AVM 患者和 97 例丘脑 AVM 患者接受 GKS 治疗，随访时间超过 2 年。病灶体积为 0.1 至 29.4cm³（平均 3.4cm³）。初始 GKS 的平均边缘剂量为 21.3Gy（范围 10-28Gy）。36 例患者在初始 GKS 后 4 年中位数时因残余 AVM 行重复 GKS。重复 GKS 的平均边缘剂量为 21.1Gy（范围 7.5-27Gy）。
单次 GKS 后，91 例患者（50%）的血管造影证实病灶完全闭塞。12 例患者（6.6%）达到次全闭塞。14 例患者（7.7%）磁共振成像未见血流空化。单次或重复 GKS 后，106 例患者（58.2%）的血管造影证实完全闭塞，8 例患者（4.4%）的次全闭塞。18 例患者（9.9%）磁共振成像未见血流空化。根据磁共振成像或血管造影，单次或多次 GKS 后的总体闭塞率为 68%。小病灶体积、高边缘剂量、低等中心点数量和无栓塞史与闭塞率增加显著相关。21 例患者在 GKS 后 850 风险年中经历了 25 次出血发作，年出血率为 2.9%。4 例患者在本系列中死亡：2 例死于出血并发症，2 例死于无关疾病。9 例（4.9%）患者因放射性引起永久性神经功能缺损。
伽玛刀手术为治疗基底节和丘脑 AVM 提供了合理的闭塞机会，且并发症风险较低。对于预期手术风险过高的患者，这是一种最佳的治疗选择。
