伽玛刀治疗脑干部位动静脉畸形  

Gamma Knife radiosurgery treatment brainstem arteriovenous malformations

作　　者：钱伟[1] 黄润生[1] 房景玉[1] 吴彩珍[1] 安有明[1] 

机构地区：[1]解放军第117医院伽玛刀治疗研究中心,杭州310013

出　　处：《立体定向和功能性神经外科杂志》2010年第2期103-105,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的回顾性伽玛刀治疗脑干动静脉畸形(brainstemarteriovenous malformation,BAVM)的疗效。方法我院自2003年3月～2009年4月应用国产MASEP头部伽玛刀治疗脑干AVM30例。患者平均年龄为23.9岁(17～38岁)。22(73%)例患者首发症状为血管瘤出血。血管畸形部位:中脑18例、桥脑9例、延髓3例。AVM体积平均为3.5 ml(0.5～7 ml)。采用核磁共振加数字减影血管造影(MRI+DSA)检查及联合定位。边缘计量12～18Gy,平均15.5Gy,45%～50%(平均48.5%)的等剂量曲线包绕脑干AVM病灶。治疗一年后经MRI及DSA复查,连续复查3年,如血管巢缩小不理想者,行复次治疗。结果随访时间12～64个月,平均28个月。使用较低剂量情况下,伽玛刀治疗脑干AVM具有较好的闭塞率;脑干AVM闭塞率与其体积、边缘计量有关。3年后随访:脑干AVM闭塞率为53.3%,年出血率为2.3%。伽玛刀治疗后大多数患者临床症状消失或改善,未出现神经功能障碍。结论伽玛刀是治疗脑干AVM安全、有效、低创的新方法,可以作为脑干AVM的首选治疗方法之一。Objective This retrospective study was designed to the outcome in brainstem arteriovenous malformations（BAVM） treated with Gamma Knife radiosurgery（GKS）.Methods thirty patients were treated with GKS at the authors＇ institution between March 2003 and April 2009.The mean age at presentation was 23.9 years（range 17～38 years）.22（73%） patients presented with hemorrhage.Anatomaical locations of these AVM included the midbrain（18 lesions）,pons（9 lesions）,and medulla oblongata（three lesions）.The mean volume of the AVMs was 3.5ml（range 0.5～7 ml）.The mean marginal dose administered was 15.5 Gy（range 12～18Gy）.follow-up was advised yearly until 3 years after GKS.If residual BAVM was present,the repeat GKS was considered admission.Results 30 patients with a mean follow-up of 28months（range 12～64 months） were included.Complete obliteration of the BAVM was documented in 16（53.3%） of the 30 patients with MRI or angiographic follow-up.Two patients experienced bleeding during the latency period.The annual hemorrhage rate was 2.3% for the first 3 years after radiosurgery.A solitary brainstem lesion can be caused by GKS as a rare complication.Conclusion GKS is an effective modality for the treatment of BAVM,yielding high obliteration rates and low complication rates.

关 键 词：伽玛刀 动静脉畸形 脑干 

分 类 号：R745.1[医药卫生—神经病学与精神病学]