X-刀治疗脑动静脉畸形54例分析  

Linear accelerator radiosurgery for brain arteriovenous malformations

作　　者：潘隆盛[1] 周定标[1] 张纪[1] 王迎选[2] 王所亭[2] 宋学堃[3] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]解放军总医院放疗科,北京100853 [3]解放军总医院放射科,北京100853

出　　处：《军医进修学院学报》2005年第3期203-205,共3页Academic Journal of Pla Postgraduate Medical School

基　　金："九五"军队科研基金项目(96M0139)

摘　　要：目的:评价X刀治疗脑动静脉畸形后临床症状和影像学结果。方法:回顾性分析我院于1994年6月至2000年3月间对54例颅内动静脉畸形患者进行立体定向X刀治疗,其中男性36例,女性18例。年龄11～52岁(平均26岁)。直径1.2～6.0cm(平均2.9cm)。其中按Spetzler Martin分级,I级13例,II级15例,III级21例,IV级5例。21例患者X刀治疗前行1次或多次栓塞。5例患者(9.3%)既往行手术切除或清除血肿。50例患者用1个等中心照射,4例患者用2个等中心照射。病变边缘照射剂量为12～23Gy(平均17.9Gy)。结果:随访时间为24～82个月(平均64.8个月)。治疗后头痛、头晕等临床症状消失的为34例(62.2%),减轻为5例(9.3%);23例癫疒间患者中9例(39.1%)癫疒间症状完全缓解,10例(43.5%)患者症状减轻,4例(17.4%)患者症状无变化。2年后的完全闭合率为81.5%(44/54)。治疗后的再出血率为3/54(5.6%),均于1年内出现,1例患者于治疗后9个月出现脑内血肿而行急诊开颅病灶切除及血肿清除术。2例患者(3.7%)出现症状性放射性脑水肿。结论:X-刀对治疗脑内动静脉畸形是安全有效的,尤其对脑深部和功能区的病变,能明显降低脑出血率,改善临床症状,降低致残率和死亡率。Objective:To estimate the results of the arteriovenous malformations treated with linear accelerater-based radiosurgery (Linac RS). Methods:Fifty-four patients with AVMs were treated between June 1994 and March 2000, there were 36 males and 18 females, mean age 26 yr(11-52 yr). The diameter of the lesions ranged 1.2-6.0cm(mean 2.9cm). The AVMs were Grade Ⅰin13 cases, Grade Ⅱin 15 cases, Grade Ⅲ in 21 cases, and Grade Ⅳ in 5 cases, according to the Spetzler-Martin Scale. Twenty-one patients (38.9%) underwent one or more embolization procedures before radiosurgery, 5 patients (9.3%) had undergone incomplete resection of their lesions. Fifty patients were treated with single isocenter and 4 patients with 2 isocenters. The marginal dose ranged from 12 to 23 Gy (mean, 17.9 Gy). The median follow-up period was 64.8 months(14-82 months). Results:Presenting symptoms included dizziness and headache were completely relieved after treatment in 34 patients(62.2%), improved in 5 patients (9.3%), and unchanged in other cases. Among the 23 patients with seizures, 9 completely relieved after radiosurgery, 10 improved and 4 were unchanged. In this series, the obliteration rate at 2 years after radiosurgery was 81.5%(44/54). Postradiosurgery hemorrhage occurred in 3 of 54 patients(5.6%) within 1 year. One patient had complete AVMs resection at 9 month after radiosurgery for its rebleeding. Two patients had delayed symptomatic radiation edema.Conclusion:Linac SRS provides a safe and effective management strategy for AVMs, especially in the deep-seated or eloquent areas. It can effectively decrease morbidity, mortality and rebleeding rate, and relieve clinical symptoms.

关 键 词：颅内动静脉畸形 放射疗法 治疗 X-刀 SRS AVMs 脑出血 

分 类 号：R743[医药卫生—神经病学与精神病学]