Shinya Yuki, Hasegawa Hirotaka, Umekawa Motoyuki, Shin Masahiro, Kawashima Mariko, Koizumi Satoshi, Katano Atsuto, Suzuki Yuichi, Kin Taichi, Saito Nobuhito
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
Acta Neurochir Suppl. 2025;136:47-59. doi: 10.1007/978-3-031-89844-0_6.
Brain arteriovenous malformations (AVMs) can cause cerebral haemorrhage, associated morbidity, and mortality if left untreated. Therefore, prophylactic interventions are essential to manage these lesions. The purpose of this study was to describe our experience of incorporating new technologies into gamma knife radiosurgery (GKRS) for AVMs, aiming to improve its effectiveness and safety.
We conducted a retrospective observational study that included 1032 patients with AVMs who underwent GKRS at our institution from 1990 to 2022. We reviewed the detailed treatment techniques and updates on GKRS, including tractography-guided identification of critical white matter fibres for eloquent AVMs, GKRS with minimal targeting embolisation for high-haemorrhage risk AVMs, and rotational angiography based GKRS for all AVMs. We evaluated the GKRS outcomes for AVM obliteration, post-GKRS haemorrhage, survival, post-GKRS signal changes, and neurological preservation.
We collected data from 90 patients by using the most advanced techniques. The cumulative obliteration rates were 61.0% at 3 years and 81.6% at 4 years, and the cumulative post-GKRS haemorrhage rates were 2.2% at 2 years and 3.6% at 5 years. Post-GKRS haemorrhage resulted in mortality in one patient (1.1%). Post-GKRS signal change was observed in 31 patients (34%), but only one (1.0%) developed a neurological deficit. Therefore, the cumulative neurological preservation rate was 97.8% at 5 years.
GKRS is a safe and effective treatment for AVMs. The continuous development and use of advanced techniques can lead to favourable outcomes for AVMs. However, further studies with larger samples and longer follow-ups, as well as an analysis of late adverse events, are necessary to better understand the efficacy and safety of GKRS for AVMs.
脑动静脉畸形（AVM）若不治疗可导致脑出血、相关的发病率和死亡率。因此，预防性干预对于处理这些病变至关重要。本研究的目的是描述我们将新技术纳入AVM伽玛刀放射外科治疗（GKRS）的经验，旨在提高其有效性和安全性。
我们进行了一项回顾性观察研究，纳入了1990年至2022年在我们机构接受GKRS治疗的1032例AVM患者。我们回顾了GKRS的详细治疗技术和进展，包括利用纤维束成像引导识别功能区AVM的关键白质纤维、对高出血风险AVM采用最小靶向栓塞的GKRS以及对所有AVM采用基于旋转血管造影的GKRS。我们评估了GKRS治疗AVM的闭塞效果、GKRS术后出血情况、生存率、GKRS术后信号变化以及神经功能保留情况。
我们采用最先进的技术收集了90例患者的数据。3年时的累积闭塞率为61.0%，4年时为81.6%，GKRS术后2年的累积出血率为2.2%，5年时为3.6%。GKRS术后出血导致1例患者死亡（1.1%）。31例患者（34%）观察到GKRS术后信号变化，但只有1例（1.0%）出现神经功能缺损。因此，5年时的累积神经功能保留率为97.8%。
GKRS是治疗AVM的一种安全有效的方法。先进技术的不断发展和应用可使AVM获得良好的治疗效果。然而，需要进行更大样本量、更长随访时间的进一步研究以及对晚期不良事件的分析，以更好地了解GKRS治疗AVM的疗效和安全性。
