Koo Ja Ho, Hwang Eui Hyun, Song Ji Hye, Lim Yong Cheol
Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
J Korean Neurosurg Soc. 2024 Jul;67(4):431-441. doi: 10.3340/jkns.2023.0177. Epub 2023 Oct 30.
Gamma Knife radiosurgery (GKRS) is an effective and noninvasive treatment for high-risk arteriovenous malformations (AVMs). Since differences in GKRS outcomes by nidus type are unknown, this study evaluated GKRS feasibility and safety in patients with brain AVMs.
This single-center retrospective study included patients with AVM who underwent GKRS between 2008 and 2021. Patients were divided into compact- and diffuse-type groups according to nidus characteristics. We excluded patients who performed GKRS and did not follow-up evaluation with magnetic resonance imaging or digital subtraction angiography within 36 months from the study. We used univariate and multivariate analyses to characterize associations of nidus type with obliteration rate and GKRS-related complications.
We enrolled 154 patients (mean age, 32.14±17.17 years; mean post-GKRS follow-up, 52.10±33.67 months) of whom 131 (85.1%) had compact- and 23 (14.9%) diffuse-type nidus AVMs. Of all AVMs, 89 (57.8%) were unruptured, and 65 (42.2%) had ruptured. The mean Spetzler-Martin AVM grades were 2.03±0.95 and 3.39±1.23 for the compact- and diffuse-type groups, respectively (p<0.001). During the follow-up period, AVM-related hemorrhages occurred in four individuals (2.6%), three of whom had compact nidi. Substantial radiation-induced changes and cyst formation were observed in 21 (13.6%) and one patient (0.6%), respectively. The AVM complete obliteration rate was 46.1% across both groups. Post-GKRS complication and complete obliteration rates were not significantly different between nidus types. For diffuse-type nidus AVMs, larger AVM size and volume (p<0.001), lower radiation dose (p<0.001), eloquent area location (p=0.015), and higher Spetzler-Martin grade (p<0.001) were observed.
GKRS is a safe and feasible treatment for brain AVMs characterized by both diffuse- and compact-type nidi.
伽玛刀放射外科治疗（GKRS）是一种治疗高危动静脉畸形（AVM）的有效且无创的方法。由于不同类型的畸形巢在GKRS治疗效果上的差异尚不清楚，本研究评估了GKRS治疗脑AVM患者的可行性和安全性。
这项单中心回顾性研究纳入了2008年至2021年间接受GKRS治疗的AVM患者。根据畸形巢特征将患者分为致密型和弥散型两组。我们排除了接受GKRS治疗后在36个月内未进行磁共振成像或数字减影血管造影随访评估的患者。我们采用单因素和多因素分析来描述畸形巢类型与闭塞率及GKRS相关并发症之间的关联。
我们纳入了154例患者（平均年龄32.14±17.17岁；GKRS术后平均随访52.10±33.67个月），其中131例（85.1%）为致密型畸形巢AVM，23例（14.9%）为弥散型畸形巢AVM。在所有AVM中，89例（57.8%）未破裂，65例（42.2%）已破裂。致密型和弥散型组的平均Spetzler-Martin AVM分级分别为2.03±0.95和3.39±1.23（p<0.001）。在随访期间，4例患者（2.6%）发生了与AVM相关的出血，其中3例为致密型畸形巢。分别有21例（13.6%）和1例患者（0.6%）观察到明显的放射诱导变化和囊肿形成。两组的AVM完全闭塞率为46.1%。畸形巢类型之间的GKRS术后并发症和完全闭塞率无显著差异。对于弥散型畸形巢AVM，观察到更大的AVM大小和体积（p<0.001）、更低的放射剂量（p<0.001）、功能区位置（p=0.015）以及更高的Spetzler-Martin分级（p<0.001）。
GKRS是一种治疗以弥散型和致密型畸形巢为特征的脑AVM的安全可行的方法。
