采用伽玛刀治疗52例青少年脑动静脉畸形

Gamma knife radiosurgery for brain arteriovenous malformations in juvenile

目的:评估伽玛刀治疗青少年脑动静脉畸形(AVM)的疗效。方法:回顾分析使用Leksell-B型伽玛刀治疗的5 2例青少年脑AVM的资料,AVM的体积0 2～31 4cm3,平均(2 7±1 5 )cm3,边缘剂量12～2 6Gy ,平均(19 8±3 6 )Gy ,4 0 %～6 5 % (平均4 8 8% )的等剂量曲线包绕脑AVM病灶。均采用磁共振成像+数字减影血管造影(MRI +DSA)联合定位。结果:随访2 4～72个月,用伽玛刀治疗后的脑AVM闭塞率与其体积、边缘剂量有关,体积<3cm3或边缘剂量>2 0Gy者2年闭塞率超过93% ,出血率为3 8% (2 / 5 2 ) ,大多数患者临床症状于伽玛刀治疗后消失或改善。结论:伽玛刀是治疗青少年脑AVM安全、有效。

Aim: To evaluate the effects of Gamma knife radiosurgery for brain arteriovenous malformations (AVM) in juvenile. Methods: Fifty-two cases with pediatric brain AVM treated by Leksell-B Gamma knife were followed up for 24 to 72 months. AVMs volume ranged from 0.2 to 31.4 cm^3, mean (2.7±1.5) cm^3. Peripheral dose of radiation ranged from 12 to 25 Gy, mean (19.8±3.6) Gy, and the AVM area was rounded by isodose curve (48.8%). Results: The rates of obliteration after Gamma knife radiosurgery were significantly related to the target volume and peripheral dosage. The two year complete obliteration rate was more than 93% in juvenile with AVM volume <3 cm^3 or peripheral dosage >20 Gy. 2 cases had recurrent hemorrhage after Gamma knife radiosurgery. Most pre-existing neurological symptoms were resolved or improved following radiosurgery. Conclusion:Gamma knife radiosurgery is safe, effective and microinvasive treatment option for juvenile brain AVM.