Moosa Shayan, Chen Ching-Jen, Ding Dale, Lee Cheng-Chia, Chivukula Srinivas, Starke Robert M, Yen Chun-Po, Xu Zhiyuan, Sheehan Jason P
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
Neurosurg Focus. 2014 Sep;37(3):E18. doi: 10.3171/2014.5.FOCUS14205.
The aim in this paper was to compare the outcomes of dose-staged and volume-staged stereotactic radio-surgery (SRS) in the treatment of large (> 10 cm(3)) arteriovenous malformations (AVMs).
A systematic literature review was performed using PubMed. Studies written in the English language with at least 5 patients harboring large (> 10 cm(3)) AVMs treated with dose- or volume-staged SRS that reported post-treatment outcomes data were selected for review. Demographic information, radiosurgical treatment parameters, and post-SRS outcomes and complications were analyzed for each of these studies.
The mean complete obliteration rates for the dose- and volume-staged groups were 22.8% and 47.5%, respectively. Complete obliteration was demonstrated in 30 of 161 (18.6%) and 59 of 120 (49.2%) patients in the dose- and volume-staged groups, respectively. The mean rates of symptomatic radiation-induced changes were 13.5% and 13.6% in dose- and volume-staged groups, respectively. The mean rates of cumulative post-SRS latency period hemorrhage were 12.3% and 17.8% in the dose- and volume-staged groups, respectively. The mean rates of post-SRS mortality were 3.2% and 4.6% in dose- and volume-staged groups, respectively.
Volume-staged SRS affords higher obliteration rates and similar complication rates compared with dose-staged SRS. Thus, volume-staged SRS may be a superior approach for large AVMs that are not amenable to single-session SRS. Staged radiosurgery should be considered as an efficacious component of multimodality AVM management.
本文旨在比较剂量分割和体积分割立体定向放射外科手术（SRS）治疗大型（>10 cm³）动静脉畸形（AVM）的疗效。
使用PubMed进行系统的文献综述。选择用英语撰写的、至少有5例接受剂量分割或体积分割SRS治疗的大型（>10 cm³）AVM患者且报告了治疗后结果数据的研究进行综述。对每项研究的人口统计学信息、放射外科治疗参数以及SRS治疗后的结果和并发症进行分析。
剂量分割组和体积分割组的平均完全闭塞率分别为22.8%和47.5%。剂量分割组161例患者中有30例（18.6%）、体积分割组120例患者中有59例（49.2%）实现了完全闭塞。剂量分割组和体积分割组有症状的放射性改变的平均发生率分别为13.5%和13.6%。剂量分割组和体积分割组SRS后累积潜伏期出血的平均发生率分别为12.3%和17.8%。剂量分割组和体积分割组SRS后的平均死亡率分别为3.2%和4.6%。
与剂量分割SRS相比，体积分割SRS具有更高的闭塞率和相似的并发症发生率。因此，对于不适合单次SRS治疗的大型AVM，体积分割SRS可能是一种更好的方法。分割放射外科手术应被视为多模式AVM治疗的有效组成部分。
