伽玛刀治疗脑动静脉畸形的疗效及影响因素分析  

Analysis on the effect and prognostic factors of cerebral arteriovenous malformations after Gamma knife radiosurgery

作　　者：於新军 刘灵慧[1] 王黎[1] 陈刚[1] 陈志癉 王向宇[1] 

机构地区：[1]暨南大学附属第一医院神经外科,广州510630

出　　处：《中国微侵袭神经外科杂志》2015年第10期440-442,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨伽玛刀对脑动静脉畸形（AVM）的疗效及影响因素。方法回顾性分析192例接受伽玛刀治疗并随访的AVM病例资料,采用卡方检验及Kaplan-Meier分析方法分析其疗效及影响因素。结果 AVM完全闭塞率为47.4%。治疗过程中出现再出血12例,迟发性脑水肿10例。伽玛刀治疗后的脑AVM闭塞情况和并发症的发生与病灶体积、Spetzler-Martin分级、最大径/最小径比值、边缘剂量、随访时间等因素有关（均P〈0.05）,其中Spetzler-Martin分级为独立影响因素（P=0.022）。结论伽玛刀是治疗脑AVM的一种安全有效的治疗方法。体积〈4 mm3、直径〈3 cm、最大径/最小径比值〈2、Spetzler-Martin分级Ⅰ级的AVM伽玛刀治疗闭塞率高,且边缘剂量以20~25 Gy为宜。Objective To explore the effect and prognostic factors of cerebral arteriovenous malformations（AVM） after Gamma knife radiosurgery. Methods The clinical data of 192 patients undergoing Gamma knife radiosurgery were analyzed retrospectively. The therapeutic efficacy and their influence factors were analyzed by the Kaplan-Meier analysis and Chi-square analysis. Results The occlusion rate of AVM was 47.4%. Rebleeding occurred in 12 patients and delayed cerebral edema in 10 during treatment. The volume of the nidus, the Spetzler-Martin grade, the maximum/minimum diameter ratio, the marginal dose and the follow-up time were found to be statistically significant in predicting the probability of AVM occlusion（all P 0.05）. The Spetzler-Martin grade was found to be an independent prognostic factor for AVM obliteration（P = 0.022）. Conclusions The gamma knife radiosurgery is an effective and safe treatment for AVM of the brain. The AVM with volumes 4 mm3, the maximum diameter less than 3 cm, the maximum/minimum diameter ratio 2, the Spetzler-Martin grade Ⅰ and the marginal dose 20-25 Gy has a higher complete occlusion rate.

关 键 词：动静脉畸形 伽玛刀 闭塞率 并发症 

分 类 号：R651.1[医药卫生—外科学]