X-刀治疗脑室脑池系统动静脉畸形26例  

An analysis of 26 cases of ventricle or cistern cerebral arteriovenous malformation treated by X-knife radiosurgery

作　　者：陈建武[1] Michel Schlienger Francois Nataf Emmanuel Touboul 郑天荣[1] 潘建基[1] 

机构地区：[1]福建省肿瘤医院放疗科,福建福州350014 [2]巴黎Tenon医院放疗科,法国巴黎75020 [3]巴黎St.Anne医院神经外科,法国巴黎75674

出　　处：《中国微侵袭神经外科杂志》2005年第5期206-208,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的总结脑室脑池系统动静脉畸形(C型A V M)的X-刀治疗效果,并讨论其治疗策略。方法采用X-刀治疗C型A V M26例,其中治疗前行栓塞9例;6例首次治疗(RS1)失败后行再次行X-刀治疗(RS2)。结果①完全闭塞率(O R)为38.5%(10例),低于本院同期705例脑A V M的55.0%(388例);P<0.005。②放疗前行血管栓塞与未行血管栓塞病人的O R分别为44.4%、35.3%。③随诊期间出血率15.4%,均为合并Ⅲ型动脉瘤的病人。④RS2的完全闭塞率为33.3%,有效率(有效+完全闭塞)50.0%。结论C型A V M大多适于行X-刀治疗;可能合并高危出血的Ⅲ型动脉瘤病人应首先考虑显微外科手术,并建议术前行血管栓塞治疗;放疗前栓塞可提高C型A V M X-刀治疗的完全闭塞率;RS2是C型A V M RS1治疗失败的补救手段。Objective To present the results of 26 patients with ventricular or cisternal cerebral arteriovenous malformation (type C AVM) treated by X-knife radiosurgery. The strategies of treatment are discussed. Methods Twenty-six cases of type C AVM treated by X-knife radiosurgery in Tenon Hospital of French were reviewed. Pre-radiosurgery embolization was used in 9 patients, and re-radiosurgery (RS2) after failure of the initial radiosurgery (RS1) performed in 6. Results ①The overall obliteration rate (OR) was 38.5% (10/26), lower than that of the whole group treated at the same period in Tenon Hospital, namely, 55% (39/705), P < 0.005. ②The OR of those with preradiosurgery embolization was 44.4%, compared with 35.3% for those without preradiosurgery embolization. ③Hemorrhage after radiosurgery occurred in 15.4% patients, all accompanied with type Ⅲ of aneurysm. ④ The OR of the patients who underwent RS2 was 33.3%, while the efficacy of RS2 was 50%. Conclusions It is always reasonable to use radiosurgery for type C AVM patients. Those accompanied with type Ⅲ of aneurysm should be treated by microsurgery because of their high frequency of hemorrhage after radiosurgery, and pre-operation embolization may also be necessary. Pre-radiosurgery embolization was helpful for improving OR of type C AVM patients. After failure of RS1 for type CAVM, RS2 should be considered as one of the best approaches of salvage.

关 键 词：颅内动静脉畸形 脑室 放射外科手术 

分 类 号：R651.12[医药卫生—外科学]