Guo W Y, Wikholm G, Karlsson B, Lindquist C, Svendsen P, Ericson K
Department of Neuroradiology, Karolinska Hospital, Stockholm, Sweden.
Acta Radiol. 1993 Nov;34(6):600-6.
In a study of 46 patients with cerebral arteriovenous malformations (AVMs) the value of combining embolization and gamma knife radiosurgery was assessed. In 35 patients with large grade III to V AVMs (Spetzler-Martin system) staged combined treatment was planned. In 11 patients, radiosurgery complemented embolization for a residual AVM. The number of embolization sessions ranged from 1 to 7 (median 2). Twenty-six patients needed multiple embolization sessions. In 28 patients the grade of AVMs decreased as a result of embolization. In 16 patients collateral feeding vessels developed after embolization which made delineation of the residual nidus difficult. The time lag between the last embolization and radiosurgery ranged from 1 to 24 months (median 4). Nineteen of 35 large grade III to V AVMs were possible to treat by radiosurgery following embolization. In the 46 patients complications occurred in 9 from embolization and in 2 from radiosurgery. Two patients had transient and 9 had permanent neurologic deficits. It is concluded that embolization facilitates radiosurgery for some large AVMs and therefore this combined treatment has a role in the management of AVMs.
在一项针对46例脑动静脉畸形（AVM）患者的研究中，评估了栓塞与伽玛刀放射外科联合治疗的价值。对于35例大型Ⅲ至Ⅴ级AVM（斯佩茨勒-马丁分级系统）患者，计划进行分期联合治疗。11例患者中，放射外科用于补充栓塞治疗残余的AVM。栓塞治疗的次数为1至7次（中位数为2次）。26例患者需要多次栓塞治疗。28例患者的AVM分级因栓塞而降低。16例患者在栓塞后出现侧支供血血管，这使得残余病灶的勾画变得困难。最后一次栓塞与放射外科之间的时间间隔为1至24个月（中位数为4个月）。35例大型Ⅲ至Ⅴ级AVM中有19例在栓塞后可行放射外科治疗。46例患者中，9例发生栓塞相关并发症，2例发生放射外科相关并发症。2例患者出现短暂性神经功能缺损，9例出现永久性神经功能缺损。研究得出结论，栓塞有助于某些大型AVM的放射外科治疗，因此这种联合治疗在AVM的管理中具有一定作用。
