Wu Chih-Chun, Guo Wan-Yuo, Chung Wen-Yuh, Wu Hsiu-Mei
Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
World Neurosurg. 2016 Mar;87:277-82. doi: 10.1016/j.wneu.2015.10.070. Epub 2015 Nov 5.
To corroborate which pretreatment angioarchitectural characteristics and posttreatment magnetic resonance imaging (MRI) features were associated with better seizure and antiepileptic drug outcomes in patients with brain arteriovenous malformations (AVMs) treated by Gamma Knife radiosurgery.
During the period 2007-2010, 220 patients with intracranial AVMs undergoing radiosurgery at our hospital were evaluated. Imaging features on digital subtraction angiography and follow-up MRI, medical records, and direct patient interview were retrospectively assessed. Seizure outcome was assessed using the Engel classification and the status of antiepileptic drug use.
At the last follow-up, 21 of 31 patients (68%) who met the recruitment criteria had AVM obliteration on digital subtraction angiography or MRI. Seizure-free status (Engel class 1) was achieved in 20 patients (65%), and 13 of 20 (65%) seizure-free patients were medication-free. The presence of total obliteration at last imaging follow-up (P = 0.013), absent retrograde cortical veins on digital subtraction angiography before GKRS (P = 0.013), nidus <3.7 cm (P = 0.006), and lower modified radiosurgery-based AVM score (P = 0.026) were significant predictors of seizure-free outcome. The strongest independent predictor of seizure-free status was absence of retrograde veins (odds ratio = 9.9). No angioarchitectural feature, postradiosurgery imaging finding on MRI, or radiosurgical treatment parameter was a significant predictor of seizure control or cessation of medication in seizure-free patients.
This study suggests that radiosurgery provides favorable outcomes in patients with AVM-related epilepsy. Patients with intracranial AVMs can benefit from seizure control after GKRS before undergoing AVM obliteration. Absence of retrograde veins is associated with better seizure-free outcomes, regardless of the parenchymal changes after radiosurgery.
证实哪些治疗前血管构筑特征和治疗后磁共振成像（MRI）特征与接受伽玛刀放射外科治疗的脑动静脉畸形（AVM）患者更好的癫痫发作和抗癫痫药物治疗效果相关。
在2007年至2010年期间，对我院220例接受放射外科治疗的颅内AVM患者进行评估。对数字减影血管造影和随访MRI的影像特征、病历以及直接的患者访谈进行回顾性评估。使用恩格尔分类法评估癫痫发作结果以及抗癫痫药物的使用情况。
在最后一次随访时，符合纳入标准的31例患者中有21例（68%）在数字减影血管造影或MRI上显示AVM闭塞。20例患者（65%）实现了无癫痫发作状态（恩格尔1级），20例无癫痫发作患者中有13例（65%）无需用药。最后一次影像随访时完全闭塞的存在（P = 0.013）、伽玛刀放射外科治疗（GKRS）前数字减影血管造影上无逆行皮质静脉（P = 0.013）、病灶<3.7 cm（P = 0.006）以及较低的基于放射外科的AVM改良评分（P = 0.026）是无癫痫发作结果的显著预测因素。无癫痫发作状态最强的独立预测因素是无逆行静脉（优势比 = 9.9）。在无癫痫发作的患者中，没有血管构筑特征、放射外科治疗后MRI上的影像表现或放射外科治疗参数是癫痫控制或停药的显著预测因素。
本研究表明放射外科治疗为AVM相关性癫痫患者提供了良好的治疗效果。颅内AVM患者在接受GKRS后，在AVM闭塞之前可从癫痫控制中获益。无论放射外科治疗后实质改变如何，无逆行静脉与更好的无癫痫发作结果相关。
