Sheen Jae Jon, Lee Do Heui, Lee Deok Hee, Song Yunsun, Kwon Do Hoon
Department of Neurological Surgery and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
World Neurosurg. 2018 Dec;120:e17-e23. doi: 10.1016/j.wneu.2018.07.046. Epub 2018 Jul 17.
We aimed to evaluate the factors associated with de novo brain cavernoma formations after patients underwent gamma knife radiosurgery (GKRS) and confirmed whether developmental venous anomaly (DVA) presented with a cavernoma and whether the cavernoma was included in the GKRS target location.
From January 2003 to December 2008, 95 patients underwent radiosurgery for brain cavernoma at our institution. Of these, 15 with multiple cavernomas related to familial cavernoma or with a history of surgical treatment for cavernoma were excluded. A total of 80 patients (44 men and 36 women; average age, 39.4 years) with sporadic cavernoma were retrospectively analyzed by considering the patient characteristics, including sex, age, target volume, radiation dose, clinical symptoms, cavernoma location, radiosurgery complications, and morphology of DVA.
The average target volume, mean radiation dose, and mean target percentage were 1019.2 mm, 13.7 Gy, and 51.1%, respectively. Nineteen patients showed cavernomas associated with DVA; of these, de novo cavernoma formations were noticed in 4 patients at a median of 49.5 months after undergoing GKRS. All de novo cavernomas were related to the presence of DVA and were located near the brainstem or cerebral peduncle. De novo cavernomas occurred when DVAs were not included in the GKRS-target location.
All de novo cavernomas were located near the brainstem or cerebral peduncle, and they occurred in the presence of DVAs. The presence of DVA in the radiosurgery target location might be potentially an important factor associated with de novo cavernoma formation.
我们旨在评估患者接受伽玛刀放射外科治疗（GKRS）后新发脑海绵状血管瘤形成的相关因素，并确认发育性静脉异常（DVA）是否与海绵状血管瘤同时出现，以及海绵状血管瘤是否包含在GKRS的靶区位置内。
2003年1月至2008年12月期间，我们机构有95例患者接受了脑海绵状血管瘤的放射外科治疗。其中，15例患有与家族性海绵状血管瘤相关的多发海绵状血管瘤或有海绵状血管瘤手术治疗史的患者被排除。通过考虑患者特征，包括性别、年龄、靶体积、放射剂量、临床症状、海绵状血管瘤位置、放射外科并发症以及DVA的形态，对80例（44例男性和36例女性；平均年龄39.4岁）散发型海绵状血管瘤患者进行了回顾性分析。
平均靶体积、平均放射剂量和平均靶区百分比分别为1019.2立方毫米、13.7 Gy和51.1%。19例患者的海绵状血管瘤与DVA相关；其中，4例患者在接受GKRS后中位时间49.5个月时出现了新发海绵状血管瘤形成。所有新发海绵状血管瘤均与DVA的存在有关，且位于脑干或脑桥附近。当DVA未包含在GKRS靶区位置时，会出现新发海绵状血管瘤。
所有新发海绵状血管瘤均位于脑干或脑桥附近，且在存在DVA的情况下发生。放射外科靶区位置存在DVA可能是与新发海绵状血管瘤形成相关的一个重要潜在因素。
