Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Stereotact Funct Neurosurg. 2024;102(1):1-12. doi: 10.1159/000534903. Epub 2023 Nov 23.
This study aimed to assess the impact of gamma knife radiosurgery on brainstem cavernous malformations (CMs).
A total of 85 patients (35 females; median age 41.0 years) who underwent gamma knife radiosurgery for brainstem CMs at our institute between 2006 and 2015 were enrolled in a prospective clinical observation trial. Risk factors for hemorrhagic outcomes were evaluated, and outcomes were compared across different margin doses.
The pre-radiosurgery annual hemorrhage rate (AHR) was 32.3% (44 hemorrhages during 136.2 patient-years). The median planning target volume was 1.292 cc. The median margin and maximum doses were 15.0 and 29.2 Gy, respectively, with a median isodose line of 50.0%. The post-radiosurgery AHR was 2.7% (21 hemorrhages during 769.9 patient-years), with a rate of 5.5% within the first 2 years and 2.0% thereafter. The post-radiosurgery AHR for patients with margin doses of ≤13.0 Gy (n = 15), 14.0-15.0 Gy (n = 50), and ≥16.0 Gy (n = 20) was 5.4, 2.7, and 0.6%, respectively. Correspondingly, transient adverse radiation effects were observed in 6.7 (1/15), 10.0 (5/50), and 30.0% (6/20) of cases, respectively. An increased margin dose per 1 Gy (hazard ratio: 0.530, 95% CI: 0.341-0.826, p = 0.005) was identified as an independent protective factor against post-radiosurgery hemorrhage. Margin doses of ≥16.0 Gy were associated with improved hemorrhagic outcomes (hazard ratio: 0.343, 95% confidence interval [CI]: 0.157-0.749, p = 0.007), but an increased risk of adverse radiation effects (odds ratio: 3.006, 95% CI: 1.041-8.677, p = 0.042).
The AHR of brainstem CMs decreased following radiosurgery, and our study revealed a significant dose-response relationship. Margin doses of 14-15 Gy were recommended. Further studies are required to validate our findings.
本研究旨在评估伽玛刀放射外科手术对脑干海绵状血管畸形（CM）的影响。
本研究共纳入了 85 例在我院于 2006 年至 2015 年间接受伽玛刀放射外科手术治疗的脑干 CM 患者（35 例女性；中位年龄 41.0 岁），进行前瞻性临床观察试验。评估了出血结果的风险因素，并比较了不同边缘剂量下的结果。
放射外科治疗前的年出血率（AHR）为 32.3%（136.2 患者年中有 44 例出血）。中位计划靶体积为 1.292cc。中位边缘和最大剂量分别为 15.0 和 29.2Gy，等剂量线的中位数为 50.0%。放射外科治疗后的 AHR 为 2.7%（769.9 患者年中有 21 例出血），前 2 年的发生率为 5.5%，此后为 2.0%。边缘剂量≤13.0Gy（n=15）、14.0-15.0Gy（n=50）和≥16.0Gy（n=20）的患者放射外科治疗后的 AHR 分别为 5.4%、2.7%和 0.6%。相应地，分别有 6.7%（1/15）、10.0%（5/50）和 30.0%（6/20）的患者出现短暂的放射性不良反应。每增加 1Gy 的边缘剂量（风险比：0.530，95%置信区间：0.341-0.826，p=0.005）被确定为放射外科治疗后出血的独立保护因素。边缘剂量≥16.0Gy 与出血结局改善相关（风险比：0.343，95%置信区间：0.157-0.749，p=0.007），但放射性不良反应的风险增加（比值比：3.006，95%置信区间：1.041-8.677，p=0.042）。
脑干 CM 患者经放射外科治疗后 AHR 下降，且本研究显示出显著的剂量反应关系。建议边缘剂量为 14-15Gy。需要进一步的研究来验证我们的发现。
