Department of Diagnostic and Interventional Neuroradiology, University Hospital Timone APHM, Marseille, France.
Department of Neurosurgery and GammaKnife Unit, Pitié Salpêtrière Sorbonne University Hospital, Paris, France.
World Neurosurg. 2022 Feb;158:e889-e895. doi: 10.1016/j.wneu.2021.11.091. Epub 2021 Nov 27.
According to A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), conservative treatment seems to be superior to any intervention for unruptured brain arteriovenous malformations (AVMs). This study aims to evaluate safety and efficacy of upfront and repeated Gamma-Knife Radiosurgery (GKRS) in patients harboring small AVMs fulfilling the inclusion criteria of ARUBA.
A retrospective study was conducted to evaluate outcomes of unruptured naive brain AVM with a volume ⩽ 5 mL eligible to ARUBA treated by GKRS with at least 3 years of follow-up.
From 1992 to 2014, 249 patients fulfilled the inclusion criteria of this study. The median age was 36 years (range: 18-78 years). The median treated volume of the nidus was 1.3 mL (range: 0.4-5 mL) and 63% of the AVM were in eloquent areas. Radiosurgery-based AVM score was 1-1.8 (76%), the Spetzler-Martin grade was II-III (73%), and the Virginia Radiosurgery AVM scale was ≤1 point (75%). The overall AVM obliteration rate was 77.1% after up to 3 GKRS sessions. The median dose at the margin was 24 Gy (15-25 Gy) and the median follow-up was 45 months (range: 36-205 months). Eight patients (3.2%) experienced hemorrhage after GKRS, corresponding to a post-GKRS hemorrhage annual rate of 1.03%. Permanent symptomatic radio-induced changes rate was 2% (4 increased seizures, 1 neurologic deficit).
The very low toxicity rate and the high occlusion rate suggest in favor of upfront and repeated GKRS for unruptured small AVMs (⩽5 mL).
根据一项未破裂脑动静脉畸形（ARUBA）的随机试验，保守治疗似乎优于任何针对未破裂脑动静脉畸形（AVM）的干预措施。本研究旨在评估符合 ARUBA 纳入标准的小 AVM 患者行 upfront 和重复伽玛刀放射外科治疗（GKRS）的安全性和有效性。
本回顾性研究评估了符合 ARUBA 纳入标准、体积≤5mL 的无脑动静脉畸形破裂的未破裂无脑动静脉畸形患者，经 GKRS 治疗至少 3 年的结果。
1992 年至 2014 年，共有 249 名患者符合本研究纳入标准。中位年龄为 36 岁（范围：18-78 岁）。病灶的中位治疗体积为 1.3mL（范围：0.4-5mL），63%的 AVM 位于功能区。基于放射外科的 AVM 评分 1-1.8（76%），Spetzler-Martin 分级 II-III（73%），弗吉尼亚放射外科 AVM 分级≤1 分（75%）。最多 3 次 GKRS 治疗后，总的 AVM 闭塞率为 77.1%。边缘的中位剂量为 24Gy（15-25Gy），中位随访时间为 45 个月（范围：36-205 个月）。8 名患者（3.2%）在 GKRS 后出现出血，相当于 GKRS 后每年出血率为 1.03%。永久性症状性放射性改变的发生率为 2%（4 例癫痫发作增加，1 例神经功能缺损）。
极低的毒性率和高闭塞率表明 upfront 和重复 GKRS 治疗小的未破裂 AVM（≤5mL）是有利的。
