Bitaraf Mohammad Ali, Katoozpour Ramon, Azar Mazyar, Nouri Mohsen, Mortazavi Seyed Abolghasem, Amirjamshidi Abbas
Department of Neurosurgery, Imam Khomeini Hospital, Ahvaz, Iran.
Rassoul Akram Hospital, Ahvaz, Iran.
Asian J Neurosurg. 2017 Apr-Jun;12(2):159-166. doi: 10.4103/1793-5482.145121.
The purpose of this study is to evaluate the outcome and risks of radiosurgery for patients with arteriovenous malformations (AVM) of the brain all treated in a single center in the 3 world with all its limitations.
We performed a retrospective analysis of 388 patients with AVM treated with radiosurgery during an 8-year period. Factors associated with increased chance of AVM obliteration or hemorrhages during the follow-up period were analyzed.
Among 388 cases included in our series, 74 were Spetzler-Martin (SM) grade IV or V. Forty-four patients (11.3%) experienced post-radiosurgery hemorrhage in their follow-up period. The number of feeders (one/multiple) and deep location of the AVM did not alter the chance of bleeding ( < 0.05). Higher SM grading of the AVM was associated with increased chance of hemorrhage and decreased obliteration rate ( > 0.05) in the mid-term follow up.
Our case series showed that radiosurgery can be considered a viable alternative in the treatment of even large AVMs which might not be considered good candidates for surgery or endovascular treatment. Further data including large size lesions are warranted to further support our findings.
本研究旨在评估在单一中心接受治疗的脑动静脉畸形（AVM）患者接受放射外科治疗的结果及风险，尽管存在各种局限性。
我们对8年间接受放射外科治疗的388例AVM患者进行了回顾性分析。分析了与随访期间AVM闭塞或出血几率增加相关的因素。
在我们纳入的388例病例中，74例为斯佩茨勒-马丁（SM）IV或V级。44例患者（11.3%）在随访期间发生了放射外科治疗后出血。供血动脉数量（单支/多支）及AVM的深部位置并未改变出血几率（P<0.05）。在中期随访中，AVM的SM分级越高，出血几率增加，闭塞率降低（P>0.05）。
我们的病例系列表明，放射外科治疗可被视为治疗甚至大型AVM的一种可行替代方法，而这些大型AVM可能不被认为是手术或血管内治疗的理想候选者。需要包括大型病变在内的更多数据来进一步支持我们的发现。
