Shimizu Atsushi, Yamaguchi Koji, Okada Yoshikazu, Funatsu Takayuki, Ishikawa Tatsuya, Hayashi Motohiro, Tamura Noriko, Horiba Ayako, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
J Neurosurg Case Lessons. 2021 Jun 21;1(25):CASE21181. doi: 10.3171/CASE21181.
Gamma Knife radiosurgery (GKRS) is a safe and effective treatment, but it has a risk of bleeding. Herein, the authors describe their experience with some patients who required surgical removal of cerebral arteriovenous malformations (AVMs) located mainly in eloquent areas of the brain after GKRS, and they consider the advantages of surgical removal after GKRS.
Twelve patients who had undergone surgical removal of AVMs after GKRS at Tokyo Women's Medical University between April 2013 and July 2019 were selected for analysis. All participants underwent GKRS as first-line therapy for AVMs located in an eloquent region or if requested by the patient. Complete obliteration was achieved in 7 patients, and the size of the nidus decreased in 3 patients during the follow-up period. The Spetzler-Martin grade decreased in 11 patients. Three patients experienced symptomatic intracerebral hemorrhage before and after confirmation of complete obliteration of the nidus via GKRS, and 7 patients experienced some neurological deficits because of an encapsulated expanding hematoma. All patients underwent resection of the nidus without complications. The preoperative neurological deficits improved in 6 patients and remained unchanged in 6 patients.
This report indicates that performing GKRS before surgery may be useful for future multimodal therapy.
伽玛刀放射外科治疗（GKRS）是一种安全有效的治疗方法，但存在出血风险。在此，作者描述了他们对一些患者的治疗经验，这些患者在接受GKRS治疗后，需要手术切除主要位于脑功能区的脑动静脉畸形（AVM），并探讨了GKRS术后手术切除的优势。
选取2013年4月至2019年7月在东京女子医科大学接受GKRS术后AVM手术切除的12例患者进行分析。所有参与者均将GKRS作为位于脑功能区或患者要求的AVM的一线治疗方法。随访期间，7例患者实现完全闭塞，3例患者的畸形瘤体积缩小。11例患者的斯佩茨勒-马丁分级降低。3例患者在通过GKRS确认畸形瘤完全闭塞前后发生有症状的脑出血，7例患者因包裹性血肿扩大出现一些神经功能缺损。所有患者均接受了畸形瘤切除术，无并发症发生。6例患者术前神经功能缺损改善，6例患者保持不变。
本报告表明，术前进行GKRS可能对未来的多模式治疗有用。
