旋转血管造影引导下伽玛刀放射外科治疗脑动静脉畸形：新方法的初步治疗结果。

Rotational Angiography-Based Gamma Knife Radiosurgery for Brain Arteriovenous Malformations: Preliminary Therapeutic Outcomes of the Novel Method.

机构信息

Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.

Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Neurosurgery. 2021 Jun 15;89(1):60-69. doi: 10.1093/neuros/nyab066.

DOI:10.1093/neuros/nyab066

PMID:33770182

Abstract

BACKGROUND

High-definition vascular imaging is desirable for treatment planning in Gamma Knife radiosurgery (GKRS; Elekta AB) for brain arteriovenous malformations (BAVMs). Currently, rotational angiography (RA) provides the clearest 3-dimensional visualization of niduses with high spatial resolution; however, its efficacy for GKRS has not been clarified. At our institution, RA has been integrated into GKRS (RA-GKRS) for better treatment planning and outcomes since 2015.

OBJECTIVE

To evaluate RA-GKRS outcomes of BAVMs and compare them with conventional GKRS (c-GKRS) outcomes.

METHODS

We retrospectively analyzed the radiosurgical outcomes of 50 BAVMs treated with RA-GKRS compared with the 306 BAVMs treated with c-GKRS. Considering possible differences in the baseline characteristics, we also created propensity score-matched cohorts and compared the radiosurgical outcomes between them to ensure comparability.

RESULTS

The obliteration time was shorter in the RA-GKRS group (cumulative rate, 88% vs 65% at 4 yr [P = .001]). Multivariate Cox proportional hazards analysis demonstrated that the RA-GKRS group (hazard ratio 2.38, 95% CI 1.58-3.60; P = .001) had a better obliteration rate. The cumulative 4-yr post-GKRS hemorrhage rates were 4.0% and 2.6% in the RA-GKRS and c-GKRS groups, respectively (P = .558). There was a trend toward early post-GKRS signal change in the RA-GKRS group compared with the c-GKRS group (cumulative rate, 38% vs 29% at 2 yr; P = .118). Those results were also confirmed in the matched cohort analyses.

CONCLUSION

The integration of RA into GKRS is promising and may provide earlier nidus obliteration.

摘要

背景

在伽玛刀放射外科（GKRS；Elekta AB）治疗脑动静脉畸形（BAVM）时，高清晰度血管成像是理想的治疗计划。目前，旋转血管造影（RA）以高空间分辨率提供了最清晰的核团 3 维可视化；然而，其对 GKRS 的疗效尚未明确。自 2015 年以来，我们的机构已将 RA 整合到 GKRS 中（RA-GKRS），以更好地进行治疗计划和结果。

目的

评估 BAVM 的 RA-GKRS 结果，并与常规 GKRS（c-GKRS）结果进行比较。

方法

我们回顾性分析了 50 例接受 RA-GKRS 治疗的 BAVM 患者的放射外科治疗结果，并与 306 例接受 c-GKRS 治疗的 BAVM 患者进行比较。考虑到基线特征可能存在差异，我们还创建了倾向评分匹配队列，并比较了它们之间的放射外科治疗结果，以确保可比性。

结果

RA-GKRS 组的闭塞时间更短（累积率，4 年时 88%对 65%；P=.001）。多变量 Cox 比例风险分析表明，RA-GKRS 组（风险比 2.38，95%CI 1.58-3.60；P=.001）具有更高的闭塞率。RA-GKRS 和 c-GKRS 组的 4 年累积 post-GKRS 出血率分别为 4.0%和 2.6%（P=.558）。与 c-GKRS 组相比，RA-GKRS 组有 post-GKRS 早期信号改变的趋势（累积率，2 年时为 38%对 29%；P=.118）。这些结果在匹配队列分析中也得到了证实。