Stereotactic Radiosurgery for Arteriovenous Malformations Located in Deep Critical Regions

被引:35
作者
Nagy, Gabor [1 ,2 ]
Major, Otto [2 ]
Rowe, Jeremy G. [1 ]
Radatz, Matthias W. R. [1 ]
Hodgson, Timothy J. [3 ]
Coley, Stuart C. [3 ]
Kemeny, Andras A. [1 ]
机构
[1] Royal Hallamshire Hosp, Natl Ctr Stereotact Radiosurg, Sheffield S10 2JF, S Yorkshire, England
[2] Natl Inst Neurosci, Budapest, Hungary
[3] Royal Hallamshire Hosp, Dept Radiol, Sheffield S10 2JF, S Yorkshire, England
关键词
Arteriovenous malformation; Brainstem; Radiosurgery; Thalamus/basal ganglia; GAMMA-KNIFE RADIOSURGERY; MARTIN GRADE-IV; TERM-FOLLOW-UP; BASAL GANGLIA; NATURAL-HISTORY; BRAIN-STEM; MULTIMODALITY TREATMENT; VASCULAR MALFORMATIONS; HEMORRHAGE; RISK;
D O I
10.1227/NEU.0b013e318246a4d0
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Radiosurgery is widely used to treat deep eloquent arteriovenous malformations (AVMs). OBJECTIVE: To evaluate how anatomic location, AVM size, and treatment parameters define outcome. METHODS: Retrospective analysis of 356 thalamic/basal ganglia and 160 brainstem AVMs treated with gamma knife radiosurgery. RESULTS: Median volume was 2 cm(3) (range, 0.02-50) for supratentorial and 0.5 cm(3) (range, 0.01-40) for brainstem AVMs; the marginal treatment doses were 17.5 to 25 Gy. After single treatment, obliteration was achieved in 65% of the brainstem, in 69% of the supratentorial, and 40% of the peritectal AVMs. Obliteration of lesions <4 cm(3) was better in the brainstem (70%) and in the supratentorium (80%), but not in the peritectal region (40%). Complications were rare (6%-15%) and mild (<= modified Rankin scale [MRS] 2). Rebleed rate increased with size, but was not higher than before treatment. AVMs >4 cm(3) in the brainstem were treated with unacceptable morbidity and low cure rate. Obliteration of large supratentorial AVMs was 65% to 47% with more complications >= MRS3. Repeat radiosurgical treatment led to obliteration in 66% of the cases with minor morbidity. CONCLUSION: Deep eloquent AVMs <4 cm(3) can be treated safely and effectively with radiosurgery. Obliteration of peritectal AVMs is significantly lower after a single treatment. However, morbidity is low, and repeat treatment leads to good obliteration. Radiosurgical treatment >4 cm(3) in the brainstem is not recommended. Supratentorial deep AVMs >8 cm(3) can be treated with radiosurgery with higher risk and lower obliteration rate. However, these lesions are difficult to treat with other treatment modalities, and a 50% success rate makes radiosurgery a good alternative even in this challenging group.
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收藏
页码:1458 / 1469
页数:12
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