Watban J A, Rodesch G, Alvarez H, Lasjaunias P
Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
Childs Nerv Syst. 1995 Jul;11(7):406-8. doi: 10.1007/BF00717406.
The authors present three cases of vein of Galen aneurysmal malformations (VGAMs) diagnosed in infancy and submitted by the referring teams for stereotactic radiosurgery as the initial therapy (therapeutic doses ranging between 20-25 Gy and 40-50 Gy to the peak dose). After the conventional follow-up of 18-24 months, no change could be detected in the angioarchitecture of the lesions. All three cases were then referred for endovascular treatment and underwent embolization by the transarterial route using liquid adhesives (N-butyl cyanoacrylate). This resulted in complete anatomical exclusion of the lesion. Regardless of the theoretical efficiency of radiosurgery in the management of brain arteriovenous malformations, the present authors believe that transarterial embolization remains the treatment of choice in VGAMs. It offers a high rate of morphological cure and the best chances for normal neurocognitive development. The time required by radiosurgery to achieve a significant result is too long for developing and maturing brain and may not prevent the negative effects of the lesion, mainly in regard to hemo- and hydrodynamic disorders (atrophy, subcortical calcifications, etc.) created by the VGAM, thus leading to irreversible mental retardation.
作者介绍了3例婴儿期诊断为大脑大静脉动脉瘤样畸形（VGAM）的病例，转诊团队将其作为初始治疗提交进行立体定向放射外科治疗（峰值剂量的治疗剂量范围在20 - 25 Gy和40 - 50 Gy之间）。经过18 - 24个月的常规随访，未发现病变的血管结构有变化。然后，所有3例病例均转诊接受血管内治疗，并通过经动脉途径使用液体粘合剂（N - 丁基氰基丙烯酸酯）进行栓塞。这导致病变在解剖学上完全闭塞。尽管放射外科治疗在脑动静脉畸形管理方面理论上有效，但作者认为经动脉栓塞仍是VGAM的首选治疗方法。它具有较高的形态学治愈率以及实现正常神经认知发育的最佳机会。对于发育中和成熟中的大脑而言，放射外科治疗取得显著效果所需的时间过长，且可能无法预防病变的负面影响，主要是关于VGAM造成的血液和流体动力学紊乱（萎缩、皮质下钙化等），从而导致不可逆转的智力发育迟缓。
