射波刀治疗脑动静脉畸形的靶区勾画和疗效分析  

Cyberknife radiosurgery for cerebral arteriovenous malformations： outlining of the radiosurgical target and obliteration

作　　者：王鑫[1] 王恩敏[1] 梅广海[1] 刘晓霞[1] 诸华光[1] 潘力[1] 戴嘉中[1] 汪洋[1] 

机构地区：[1]复旦大学附属华山医院神经外科,射波刀治疗中心,上海200040

出　　处：《中华医学杂志》2014年第37期2902-2906,共5页National Medical Journal of China

摘　　要：目的 总结射波刀治疗脑动静脉畸形（AVM）的靶区勾画与治疗效果.方法 对象为2008年1月至2011年10月在华山医院射波刀治疗的AVM病人,共51例.51例中联合栓塞治疗24例;伽玛刀后残留2例;直接射波刀治疗25例.AVM照射靶区：包括了AVM血管巢、少量引流静脉.如果AVM较大已经做过栓塞治疗,照射靶区包括部分已经栓塞AVM、少量引流静脉和全部未栓塞AVM,但是照射在引流静脉和已经栓塞AVM的剂量适度降低.对全部病例进行随访,随访时间46（36 ～70）个月.结果 射波刀治疗后3年复查MRI和DSA显示40例（78％）AVM基本闭塞消失.11例AVM未闭塞,但明显缩小.通过分析射波刀治疗计划发现,联合栓塞治疗的中等到大体积AVM,射波刀照射范围包括未闭塞AVM、已经栓塞的AVM和少量引流静脉者,治疗后AVM闭塞率高.结论 射波刀治疗小体积AVM不良反应轻,完全闭塞.栓塞联合射波刀治疗中等到大体积AVM时,照射靶区范围与闭塞率直接相关.Objective To explore the therapeutic outcomes of cyberknife for patients with arteriovenous malformations （AVM） and outline the content of AVM targets.Methods Between January 2008 and October 2011,51 patients underwent cyberknife radiosurgery for cerebral AVMs.The mean age was 27 （8-47） years.The procedures included prior embolization （n =24）,gamma knife before cyberknife （n =2） and cyberknife initially （n =25）.The delineation of AVM targets was as follows：AVM with prior embolization,radiosurgical targets included AVM nidus,embolization areas and some small draining veins.However,low radiation dose was delivered to embolization parts and draining veins.For 25 patients without embolization,the radiosurgical target was AVM nidus.The mean target volume was 7.8 （1.2-22.0） cm^3 and 15 of them were larger than 10.0 cm^3.In patients harboring AVM with target volumes 〈 4 cm^3,cyberknife radiation was delivered in a single session.And the remainder had 2 （n =25） or3 （n=19） sessions.The mean marginal dose was 23（18-28） Gy.Results AVM obliteration was confirmed by magnetic resonance imaging （MRI） or angiography in 40 （78%） patients during a mean follow-up of 46 （36-70） months.Marked size reduction of AVM was obtained in 11 incompletely obliterated patients.Among them,there were second cyberknife treatment （n =3）,third embolization for complex AVM （n =1）,gamma knife （n =1） and further follow-ups （n =6）.The higher obliteration rate of AVM was correlated with small volume of AVM in noncritical areas,prior embolization and radiation target of embolization areas.Three patients had hemorrhage during the follow-up period and recovered.Brain edema was found in patients with basal ganglion or parietal AVMs.A permanent neurological deficit （paralysis） due to adverse radiation effects developed in 1 patient.Conclusion Cyberknife radiosurgery is particularly effective for patients with smaller AVMs in noncritical areas of brain.In patients with prior embolization,d

关 键 词：脑动静脉畸形 放射外科 射波刀 伽玛刀 血管内栓塞 

分 类 号：R743.4[医药卫生—神经病学与精神病学]