丘脑动静脉畸形的立体定向放射外科治疗
Stereotactic radiosurgery for thalamus arteriovenous malformations.
作者信息
Faye Mohameth, Diallo Moussa, Sghiouar Manal, Ndiaye Sy Elhadji Cheikh, Borius Pierre Yves, Régis Jean-Marie
机构信息
Service de Neurochirurgie Fonctionnelle et Stéréotaxique, Hôpital de la Timone, 249, rue Saint-Pierre, F-13005 Marseille, France.
Service de Neurochirurgie, Hôpital Nord, chemin des Bourrely, F-13915, Marseille, France.
出版信息
J Radiosurg SBRT. 2020;6(4):269-275.
BACKGROUND
Cerebral arteriovenous malformations or angiomas are congenital vascular anomalies defined by abnormal arteriovenous shunt.
MATERIALS AND METHODS
We conducted a retrospective study between January 1992 and December 2010 at the Timone Hospital radiosurgery unit, 1557 patients were treated by radiosurgery for arteriovenous malformation of which 53 for thalamic localization (3,4%).
RESULTS
The mean age was 35.8-/+16.6 years (4-75). 14 patients underwent pre-radiosurgical embolization (26.4%), discovery mode for 47 patients (88.7%) was haemorrhage. The average treatment volume was 1.43 cm. The average RBAS score was 1.36. The average prescription to the 50% isodose envelope delivered was 22.9 +/-2.9 Gy (12-30), the median margin dose was 24 Gy. Our global obliteration rate after one or two procedures 66.7% for an average follow-up period of 56.7 months. We noted 3.9% of mortality, 5.9% of bleeding after procedure and 3.9% of radio-induced neurological deficit.
CONCLUSION
Radiosurgery became indispensable in the treatment of thalamic AVM even when there is a persistent risk of haemorrhage until total recovery.
背景
脑动静脉畸形或血管瘤是由异常动静脉分流定义的先天性血管异常。
材料与方法
我们于1992年1月至2010年12月在蒂莫内医院放射外科进行了一项回顾性研究，1557例患者接受了放射外科治疗动静脉畸形，其中53例位于丘脑（3.4%）。
结果
平均年龄为35.8±16.6岁（4 - 75岁）。14例患者在放射外科治疗前接受了栓塞治疗（26.4%），47例患者（88.7%）的发现方式为出血。平均治疗体积为1.43立方厘米。平均RBAS评分为1.36。50%等剂量包络的平均处方剂量为22.9±2.9 Gy（12 - 30），中位边缘剂量为24 Gy。在平均56.7个月的随访期后，经过一或两次治疗后的总体闭塞率为66.7%。我们注意到死亡率为3.9%，治疗后出血率为5.9%，放射性神经功能缺损率为3.9%。
结论
放射外科在丘脑动静脉畸形的治疗中变得不可或缺，即使在完全恢复之前仍存在持续出血风险。
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