Lenck Stéphanie, Schwartz Michael, Hengwei Jin, Agid Ronit, Nicholson Patrick, Krings Timo, Tymianski Michael, Mendes-Pereira Vitor, Radovanovic Ivan
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2018 Aug;116:e1105-e1113. doi: 10.1016/j.wneu.2018.05.180. Epub 2018 Jun 1.
To assess outcome of residual brain arteriovenous malformation (BAVM) after stereotactic radiosurgery.
Patients with residual BAVM 3 years after radiosurgery were retrospectively included. Demographics, angioarchitectural characteristics, complications, bleeding, and cure rates of patients with intervention or conservative management (i.e., observation) were compared. We analyzed characteristics of patients treated conservatively who achieved cure or still had persistent BAVMs during follow-up.
The study included 87 patients including 5 patients with subtotal obliteration with a mean follow-up time of 33.7 ± 36.6 months. Of patients, 27 (31.0%) received subsequent treatment (radiosurgery, n = 23; microsurgery, n = 3; embolization, n = 1), and 60 (69%) were treated conservatively. After repeat SRS, 4 (14.8%) patients experienced symptomatic complications after the second treatment, and 7 (25.9%) experienced asymptomatic changes. Three (3.4%) patients, all of whom presented initially with a ruptured BAVM, experienced hemorrhage during follow-up. Subsequent treatment was effective with a complete cure of BAVM in 11 patients (40.7%). Complete resolution of the residual BAVM occurred in 15 (25%) patients treated conservatively.
Complete obliteration of a significant number of residual BAVMs may occur 3-5 years after the first irradiation, whereas increased radiation dose associated with repeat SRS may lead to an increased risk of complications. The fact that the interval risk of bleeding decreased after SRS (especially for ruptured BAVM) lends further strength to the argument for a conservative management approach for residual BAVM 3-5 years after the first irradiation.
评估立体定向放射治疗后残留脑动静脉畸形（BAVM）的治疗效果。
回顾性纳入放射治疗后3年仍有残留BAVM的患者。比较接受干预或保守治疗（即观察）患者的人口统计学特征、血管构筑特征、并发症、出血情况及治愈率。我们分析了保守治疗患者在随访期间达到治愈或仍有持续性BAVM的特征。
该研究纳入了87例患者，其中5例为次全闭塞，平均随访时间为33.7±36.6个月。患者中，27例（31.0%）接受了后续治疗（放射治疗，n = 23；显微手术，n = 3；栓塞，n = 1），60例（69%）接受了保守治疗。再次进行立体定向放射治疗后，4例（14.8%）患者在第二次治疗后出现有症状的并发症，7例（25.9%）出现无症状改变。3例（3.4%）患者在随访期间发生出血，所有这些患者最初均表现为BAVM破裂。后续治疗有效，11例患者（40.7%）的BAVM完全治愈。15例（25%）接受保守治疗的患者残留BAVM完全消失。
首次照射后3 - 5年，大量残留BAVM可能完全闭塞，而与再次立体定向放射治疗相关的辐射剂量增加可能导致并发症风险增加。立体定向放射治疗后出血的间隔风险降低（尤其是对于破裂的BAVM）这一事实，进一步支持了对首次照射后3 - 5年的残留BAVM采取保守治疗方法的观点。
