98例脑动静脉畸形伽玛刀治疗逐年随访6年分析

Gamma knife radiosurgery for cerebral arteriovenous malformation:Report of 98 cases after follow-up of 6 years

目的 评估伽玛刀 (γ 刀 )治疗脑动静脉畸形 (cAVM)的疗效。方法 对 1 996年 1月 1日至 1 996年1 2月 31日在我科行Leksellγ 刀手术治疗cAVM的患者 96例 ,进行逐年随访。患者年龄 3.5～ 74岁 ,AVM体积0 .3～ 39.2cm3 ,Spetzler Martin分级 :Ⅰ级 2 2例 ,Ⅱ级 35例 ,Ⅲ级 36例 ,Ⅳ级 4例 ,Ⅴ级 1例 ,治疗边缘剂量为 1 2～30Gy。结果 γ 刀治疗后的闭塞情况和并发症的发生与其体积、分级、边缘剂量及距离治疗时间的长短等有关。本组有效率 98.9%。对边缘剂量≥ 2 0Gy、血管巢体积≤ 5cm3 、Spetzler Martin分级≤Ⅱ级 ,完全闭塞率为 82 .3%。所有病例 2年内完全闭塞率 5 2 .0 % ,6年内完全闭塞率 6 6 .3%。本组 2例再出血 ,4例并发较明显症状的放射性脑水肿。结论 γ 刀是治疗cAVM的一种安全、有效的方法 ,特别对血管巢体积≤ 5cm3 、Spetzler Martin分级Ⅰ～Ⅱ级、边缘剂量≥ 2 0Gy者。血管巢多在治疗后 2年内闭塞 ,6年内仍有闭塞。

Objective To evaluate the effects of gamma knife radiosurgery on cerebral arteriovenous malformations (cAVM).Methods Ninty eight patients with cAVM treated by Leksell γ knife,treated during 1996,were followed up year by year for 6 years.The age of the patients were ranged from 3.5 to 74 years.AVM volume ranged from 0.3 to 39.2 cm 3,peripheral dose of radiation ranged from 12 to 30 Gy.Spetzler Martin grading:grade Ⅰ 22 cases,grade Ⅱ 35 cases,grade Ⅲ 36 cases,grade Ⅳ 4 cases and grade Ⅴ 1 cases.Results The probability of obliteration and the complications of cAVM after γ knife surgery were significantly related to the target volume,the grading of the lesions,the peripheral dosage,the time after treated,and so on.The complete obliteration rate was 82.3% in the patients with AVM volume ≤5cm 3 or ≤ grade Ⅱ of Spetzler Martin grading system and the peripheral dosage ≥20 Gy.And in the all patients, the complete obliteration rate after 2 years and 6 years was 52.0% and 66.3% respectively.Two cases had recurrent hemorrhage after γ knife radiosurgery and 4 cases complicated apparent symptom of irradiated brain edema.Conclusions The γ knife is an effective and safe method for the treatment of AVM.There is a higher obliteration rate for AVM of grade Ⅰ-Ⅱ or the volume ≤5cm 3 and the peripheral dosage ≥20 Gy.Follow-up is important after AVM treated by γ-knife.The most nidus became complete obliteration during 2 years,but small during 6 years.