X刀治疗脑血管畸形(附45例临床分析)

LINAC radiosurgery for cerebral vascular malformation: an analysis of 45 cases

目的 :总结 X刀治疗脑血管畸形效果。方法 :脑动静脉畸形 ( AVM) 3 1例 ,脑海绵状血管瘤 1 4例。AVM和海绵状血管瘤 X刀周边剂量分别为 ( 2 2 .6± 3 .8) Gy和 ( 2 4 .0± 3 .9) Gy。随访 1 2～ 60个月 ,平均 ( 3 5.3 5± 1 7.60 )个月。结果 :AVM完全闭塞 1 8例 ,部分闭塞 1 1例 ,无闭塞 2例。海绵状血管瘤 X刀治疗后未发生脑出血 ,大多数癫发作缓解 ,但血管瘤无 1例消失。出现症状性放射性脑水肿 6例 ,均为 AVM患者。结论 :X刀是治疗脑血管畸形较有效的治疗方法 ,但要掌握适应证 ,选择合适剂量 ,防止脑水肿并发症发生。

Objective: : To investigate the effect of radiosurgery on p atients with cerebral vascular malformation. Methods: Thirty-o ne patients with cerebral arteriovenous malformations(AVM) and 14 patients with cavernous angiomas were treated by linear accelerator radiosurgery. The median A VM marginal dose was (22.6±3.8) Gy, the median cavernous angiomas marginal dose was (24.0±3.9) Gy. The median follow-up was a (35.35±17.60) months. Results: Eighteen patients had complete obliteration of AVM,11 had part ial obliteration of AVM. There was marked reduction of seizure frequency and no rebleeding in patients with cavernous angiomas, but none of cavernous angiomas d isappeared. Brain edema was found in 6 patients with AVM. Conclusion:Linear accelerator radiosurgery is effective for vascular malformation. Th e brain edema is a common complication, which may be minimized by choosing adapt ive vascular malformation and adaptive radiosurgical dose.