立体定向放射治疗脑动静脉畸形38例分析

Analysis of 38 cases of brain arteriovenous malformations by stereotactic locating radiotherapy

目的分析立体定向放射治疗脑动静脉畸形（AVM）的方法、疗效。方法设置靶点数1～2个,靶点边缘剂量18～25Gy（平均20.4Gy）,70%～85%等剂量线覆盖病灶,采用600C直线加速器6mv X线对38例脑动静脉畸形患者实施非共面、旋转照射。结果随访1～36个月,平均26个月,2年内AVM完全闭塞78.9%,部分闭塞15.7%,无变化5.4%,癫痫缓解率83%,头痛缓解率78%。2例于2周内出现急性脑水肿症状,6～8个月影像显示18例慢性脑水肿,其中2例出现临床症状,均经对症处理症状缓解。结论立体定向放射治疗对深部或重要功能区的AVM、术后残留或不能、不愿手术者是一种安全有效的方法。

Objective To analyze and evaluate the method and curative effect of stereotactic radiotherapy（SRT） for brain arteriovenous malformations （AVM）. Methods Target numbers were setted. The peripheral does were 18～25Gy （average 20.4Gy）. The focus was covered by 70G ～85G equal dose line. Thirty-eight patients with AVM were treated by noncoplanarity and rotating radiotherapy through 6mV X-ray 600C linear accelerator. Results The follow-up period ranged from 1 to 36 months （average 26 months）. Within 2 years, 78.9% patients were obturated completely, 15.7% obturated partly, 5.4% unchanged. Falling sickness relieved 83% after radiosurgery, headache relieved 78%. 2 patients appeared acute hydrocephalus within two weeks. 18 patients appeared chronic hydrocephalus within 6～8 months by image display. 2 patients had clinical symptom. The symptom was relieved after treatment. Conclusion Stereotactic locating radiotherapy will be a safe treatment method for AVM with deep and important function place, as well as patients have rudimental symptom after operation or can＇t and don＇t want to be operated.