Park Kawngwoo, Kim Jin Wook, Chung Hyun-Tai, Paek Sun Ha, Kim Dong Gyu
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
World Neurosurg. 2018 Aug;116:e1054-e1059. doi: 10.1016/j.wneu.2018.05.164. Epub 2018 Jun 2.
We sought to analyze the long-term outcome of Gamma Knife radiosurgery (GKS) for symptomatic brainstem cavernous malformation (s-BSCM).
Forty-five patients (14 males, 31 females) were treated with GKS for s-BSCM from January 1998 to December 2011. All patients were followed up for >5 years, and their clinical data were analyzed retrospectively. All patients had a history of symptomatic bleeding once or more before GKS. These hemorrhages caused neurologic deficits including cranial nerve deficits, hemiparesis, hemisensory deficits, spasticity, or chorea. The mean target volume of s-BSCM was 1.82 cm, and the median prescribed marginal dose of radiation was 13 Gy. The mean clinical and imaging follow-up period was 9.31 years (range 5.1-19.4 years).
The 45 patients had 69 hemorrhagic events before GKS. During the follow-up period after GKS, 35 patients had no hemorrhagic event, 6 patients had 1 episode of symptomatic hemorrhage, and 4 patients had 2 episodes. The calculated annual hemorrhage rate was 40.06% at pre-GKS, 3.3% at 2 years after GKS, 1.48% at 5 years after GKS, and 4.64% at >5 years after GKS. In this study of 45 patients, symptomatic radiation-induced complications developed in only 1 patient (2.2%). No patients had died at the last follow-up.
GKS for s-BSCM is a safe and effective alternative to surgical resection for reducing the rate of recurrent hemorrhage. Because the annual hemorrhage rate increases >5 years after GKS, clinicians should monitor patients closely to determine their subsequent treatment.
我们试图分析伽玛刀放射外科治疗（GKS）有症状的脑干海绵状血管畸形（s-BSCM）的长期疗效。
1998年1月至2011年12月期间，45例患者（14例男性，31例女性）接受了GKS治疗s-BSCM。所有患者均接受了超过5年的随访，并对其临床资料进行了回顾性分析。所有患者在接受GKS治疗前均有一次或多次有症状出血史。这些出血导致神经功能缺损，包括脑神经缺损、偏瘫、偏身感觉障碍、痉挛或舞蹈症。s-BSCM的平均靶体积为1.82 cm，辐射的中位处方边缘剂量为13 Gy。平均临床和影像学随访期为9.31年（范围5.1 - 19.4年）。
45例患者在GKS治疗前有69次出血事件。在GKS治疗后的随访期间，35例患者无出血事件，6例患者有1次有症状出血发作，4例患者有2次发作。计算得出GKS治疗前的年出血率为40.06%，GKS治疗后2年为3.3%，GKS治疗后5年为1.48%，GKS治疗后>5年为4.64%。在这项对45例患者的研究中，仅1例患者（2.2%）出现了有症状的放射性并发症。在最后一次随访时无患者死亡。
GKS治疗s-BSCM是一种安全有效的替代手术切除的方法，可降低复发出血率。由于GKS治疗后>5年年出血率会增加，临床医生应密切监测患者以确定其后续治疗。
