Tripathi Manjul, Batish Aman, Mohindra Sandeep
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Neurosci Rural Pract. 2021 Jan;12(1):182-184. doi: 10.1055/s-0040-1716795. Epub 2020 Oct 27.
Intracranial aneurysms are vascular malformations with significant mortality and morbidity profile. Various treatment modalities have been developed to positively impact the outcome profile with gradual shift to the minimally invasive treatment modalities. Gamma knife radiosurgery (GKRS) is an established primary treatment modality for various intracranial arteriovenous malformations (AVMs); however, its efficacy for berry aneurysmal obliteration has been historically dismal. The aim of this study is to evaluate the factors responsible for poor radio surgical outcome for intracranial aneurysms. The literature is reviewed for the differential efficacy of GKRS for aneurysm and AVM. Though both are vascular malformations, aneurysm and AVM have inherent differences in angioarchitecture, intracranial location, surrounding neighborhood, radio-sensitivity, and latency for obliteration. The major difference arises because of surrounding neighborhood of connective tissue stroma which stabilizes the irradiated pathology. Though considered radioresistant, aneurysms show promising results with animal models of radiosurgery. The future lies in two hypothetical improvements: with a supporting neighborhood or sensitization of the vessel wall that may change the natural history of an aneurysm, especially an unruptured one.
颅内动脉瘤是具有显著死亡率和发病率的血管畸形。已经开发了各种治疗方式来积极影响治疗结果，且逐渐转向微创治疗方式。伽玛刀放射外科手术（GKRS）是治疗各种颅内动静脉畸形（AVM）的一种既定的主要治疗方式；然而，其对囊状动脉瘤闭塞的疗效历来不佳。
本研究的目的是评估导致颅内动脉瘤放射外科手术效果不佳的因素。
回顾了关于GKRS治疗动脉瘤和AVM的不同疗效的文献。
尽管动脉瘤和AVM都是血管畸形，但它们在血管结构、颅内位置、周围组织、放射敏感性和闭塞潜伏期方面存在固有差异。主要差异源于结缔组织基质的周围组织，它能稳定受照射的病变。
尽管动脉瘤被认为具有放射抗性，但在放射外科手术的动物模型中显示出了有前景的结果。未来在于两种假设的改进：拥有支持性的周围组织或使血管壁敏感化，这可能会改变动脉瘤的自然病程，尤其是未破裂的动脉瘤。
