Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Clin Neurosci. 2012 Jul;19(7):1001-4. doi: 10.1016/j.jocn.2012.01.004. Epub 2012 May 17.
Microsurgical resection of a cerebral arteriovenous malformation (AVM) allows for an immediate therapeutic cure. Stereotactic radiosurgery (SRS) is a reasonable alternative for inoperable or high-risk lesions requiring treatment. Few series evaluate overall results that include data from both modalities as they more often focus on their treatment method of choice. In this study, we evaluated our AVM database of 129 patients seen over the past eight years at our institution: 73 were treated with microsurgery (57%) while 37 (29%) were treated with SRS. We reviewed angiographic obliteration rates, complication rates, and outcome data, excluding seven patients treated with SRS as they did not have at least two years of angiographic follow-up. Patients undergoing microsurgery had smaller AVM (mean 2.2 cm compared to 3.5 cm for SRS), a smaller proportion of eloquent AVM (53% compared to 83% for SRS), a greater proportion of AVM with superficial drainage only (75% compared to 40% for SRS), and more grade 1 and 2 AVM (78% compared to 17% for SRS). The overall obliteration rate was 80%: 92% for microsurgery and 50% for SRS. The latter increased to 92% for AVM <3 cm, but the obliteration rate was 18% for those AVM >3 cm. Transient complications, including post-SRS hemorrhage, were seen in 11% of patients overall (8% after microsurgery, 17% after SRS). At follow-up, 53% of patients had improved, 37% remained the same, 7% had become worse and 3% had died. As a result of post-SRS hemorrhage, a greater proportion of patients was worse or had died after SRS (20%) compared to those who had been treated with microsurgery (5%).
脑动静脉畸形（AVM）的显微切除术可以立即进行治疗。立体定向放射外科（SRS）是一种合理的替代方法，适用于需要治疗但无法手术或风险较高的病变。很少有系列研究评估包括两种治疗方式的数据的总体结果，因为它们通常更侧重于其首选的治疗方法。在这项研究中，我们评估了过去八年来在我们机构就诊的 129 名患者的 AVM 数据库：73 名患者接受了显微手术治疗（57%），37 名患者（29%）接受了 SRS 治疗。我们回顾了血管造影闭塞率、并发症发生率和结果数据，排除了 7 名接受 SRS 治疗的患者，因为他们没有至少两年的血管造影随访。接受显微手术的患者的 AVM 较小（平均 2.2 厘米，而 SRS 为 3.5 厘米），语言区 AVM 的比例较小（53%，而 SRS 为 83%），仅有表浅引流的 AVM 比例较大（75%，而 SRS 为 40%），1 级和 2 级 AVM 比例较高（78%，而 SRS 为 17%）。总体闭塞率为 80%：显微手术为 92%，SRS 为 50%。对于 AVM <3 厘米的患者，闭塞率增加到 92%，但 AVM >3 厘米的患者的闭塞率为 18%。包括 SRS 后出血在内的短暂性并发症在所有患者中的发生率为 11%（显微手术后为 8%，SRS 后为 17%）。在随访中，53%的患者病情好转，37%的患者病情保持不变，7%的患者病情恶化，3%的患者死亡。由于 SRS 后出血，SRS 治疗后病情恶化或死亡的患者比例（20%）高于接受显微手术治疗的患者（5%）。
