Melbourne School of Psychological Sciences, Redmond Barry Building, The University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
Radiation Oncology, Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.
J Clin Neurosci. 2014 Apr;21(4):601-6. doi: 10.1016/j.jocn.2013.08.007. Epub 2013 Aug 31.
To our knowledge, this is the first study to investigate cognitive outcome in patients with large or surgically inaccessible cerebral arteriovenous malformations (AVMs), who were treated with hypo-fractionated stereotactic radiotherapy (HSRT). A sample of 10 patients with AVMs was assessed up to 3.5 years post-HSRT. All patients were treated with HSRT to a total dose of 55 Gy in 11 fractions over a treatment period of 2.5 weeks. Neuropsychological assessments were given prior to radiotherapy and then at three time points following radiotherapy: 6 weeks, 6 months and 2.5-3.5 years post-treatment. The cognitive domains of attention, processing speed, learning, memory, semantic processing, naming, verbal fluency, visuospatial and executive function were assessed. Findings revealed that prior to radiotherapy the patient group was impaired in five of the nine cognitive domains. Post-treatment performances remained stable in the majority of domains; however, there was some fluctuation in semantic processing and memory performances. At 6 weeks post-treatment, a mild decrement was found in semantic processing ability; however, restoration to baseline levels was observed from 6 months onwards. At 2.5-3.5 years post-treatment, improvement was seen in the cohort's ability to remember new information when performances were compared with earlier time points. This study demonstrated improvements in memory several years after HSRT treatment. Further, this form of treatment was not associated with long-term, harmful cognitive side effects for these 10 patients encouraging further study of this treatment method. Further evaluation of the entire cohort is required to assess efficacy in terms of AVM obliteration and other potential side effects.
据我们所知，这是第一项研究调查认知结果在患者大或手术无法到达大脑动静脉畸形（AVM），谁接受了低分割立体定向放射治疗（HSRT）。AVM 患者的样本 10 在 HSRT 后长达 3.5 年进行了评估。所有患者均接受 HSRT 治疗，总剂量为 55 Gy，11 次，治疗期为 2.5 周。在放射治疗前和放射治疗后三个时间点进行神经心理学评估：6 周、6 个月和 2.5-3.5 年。评估了注意力、处理速度、学习、记忆、语义处理、命名、言语流畅性、视空间和执行功能等认知领域。研究结果表明，在放射治疗前，患者组在九个认知领域中的五个领域受损。治疗后大多数领域的表现保持稳定；然而，语义处理和记忆表现有些波动。在治疗后 6 周时，发现语义处理能力轻度下降；然而，从 6 个月开始，恢复到基线水平。在治疗后 2.5-3.5 年，与早期时间点相比，患者记住新信息的能力有所提高。这项研究表明，在 HSRT 治疗后几年内，记忆能力有所提高。此外，这种治疗方法与这 10 名患者的长期、有害的认知副作用无关，鼓励进一步研究这种治疗方法。需要进一步评估整个队列，以评估 AVM 闭塞和其他潜在副作用方面的疗效。
