应用X刀治疗脑动静脉畸形87例

X-knife treatment for 87 cases of cerebral arteriovenous malformation

目的探讨立体定向放射外科治疗脑动静脉畸形的临床效果.方法对87例脑动静脉畸形患者采用X刀治疗,动静脉畸形团大小为5～40 mm.87例中单独接受X刀治疗55例,联合血管内栓塞治疗32例.治疗周边剂量17～30 Gy,平均22.6Gv,等剂量曲线70%～90%.随访时间6～96个月,平均53.4个月.结果单独接受X刀治疗的脑动静脉畸形患者,41例完全闭塞,9例部分闭塞,5例无变化;联合血管内栓塞治疗的患者,26例完全闭塞,3例部分闭塞,3例无变化.两组患者完全闭塞67例(77.01%),癫痫完全缓解7例(26.17%),头痛、头昏症状缓解18例(38.30%),再出血2例,症状性放射性脑水肿6例.经治疗后,完全缓解2例,遗留神经功能障碍4例.结论立体定向放射外科治疗是脑动静脉畸形的安全而有效的治疗方法之一.

Objective To investigate the efficacy and complications of X-knife treatment to cerebral ar-teriovenous malformation (cAVM). Methods 87 patients of cAVM, with the size of nidus ranged from 5 to 40mm, were evaluated retrospectively. There were 56 males and 31 females, aged from 9 to 66 years old ( average: 55. 36). 55 patients were treated by X-knife only, the rest patients underwent pre-radiosurgery embolization. The dose at the peripheral isoline (70% -90% ) ranged from 17 to 30 Gy, with the mean dose of 22. 6 Gy. The median follow-up period was 53. 36 months (ranged from 6 - 96 months). Results In patients treated by X-knife only, 41 cases of cAVM were occluded completely, 9 cases were occluded partially, and 5 cases had no change. Correspondingly, the number were 26, 3 and 3 in patients treated by combined embolization with radiosurgery. Total number of complete occlusive cases was 67 (77. 01% ). 7 cases (26. 17% ) were seizure-free and 18 cases (38. 3% ) were free from headache and dizziness. 2 cases suffered from rebleeding at 3 and 11 months after radiosurgery. 6 patients had radioactive cerebral edema, and 4 of them experienced permanent neurological deficits. Conclusion X-knife is a safe and effective method to treat cAVM.