Kjellberg R N, Hanamura T, Davis K R, Lyons S L, Adams R D
N Engl J Med. 1983 Aug 4;309(5):269-74. doi: 10.1056/NEJM198308043090503.
Patients with arteriovenous malformations of the brain, who are subject to disabling or fatal recurrent hemorrhage, seizures, severe headache, and progressive neurologic deficits, may be considered unsuitable for conventional therapies (craniotomy with excision or embolization), usually because of the location, size, or operative risk of the lesion. We have treated such patients with stereotactic Bragg-peak proton-beam therapy and report the follow-up of 74 of the first 75, 2 to 16 years after treatment. Proton-beam therapy is intended to induce subendothelial deposition of collagen and hyaline substance, which narrows the lumens of small vessels and thickens the walls of the malformation during the first 12 to 24 months after the procedure. Two deaths from hemorrhage occurred in the first 12 months after treatment, but no lethal or disabling hemorrhages occurred after this interval. Seizures, headaches, and progressive neurologic deficits were in most cases arrested or improved. Bragg-peak proton-beam therapy appears to be a useful technique for treatment of intracranial arteriovenous malformations, especially those that are unsuitable for treatment by other methods.
患有脑动静脉畸形的患者，可能会因反复出血、癫痫发作、严重头痛和进行性神经功能缺损而致残或致死，通常由于病变的位置、大小或手术风险，这些患者可能被认为不适合传统治疗（开颅切除或栓塞）。我们采用立体定向布拉格峰质子束疗法治疗了此类患者，并报告了首批75例患者中74例在治疗后2至16年的随访情况。质子束疗法旨在诱导胶原和透明质物质在内皮下沉积，在治疗后的头12至24个月内使小血管腔变窄，使畸形血管壁增厚。治疗后的前12个月内发生了2例出血死亡，但在此间隔之后未发生致命或致残性出血。癫痫发作、头痛和进行性神经功能缺损在大多数情况下得到了控制或改善。布拉格峰质子束疗法似乎是治疗颅内动静脉畸形的一种有用技术，尤其是那些不适合用其他方法治疗的畸形。
