伽玛刀治疗儿童颅内动静脉畸形的远期疗效及其影响因素分析  

Long-term therapeutic effect of gamma knife treatment for intracranial arteriovenous malformations in children and analysis of its influencing factors

作　　者：高德智[1,2] 孟祥雨 孙时斌 王美华[1,2] 刘阿力[1,2] Gao Dezhi;Meng Xiangyu;Sun Shibin;Wang Meihua;Liu Ali(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Gamma Knife Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,100070 [2]首都医科大学附属北京天坛医院伽玛刀中心,100070

出　　处：《中华神经外科杂志》2021年第12期1239-1245,共7页Chinese Journal of Neurosurgery

基　　金：北京市神经外科研究所创新探索基金(2017所创新(10));中华国际医学交流基金会肿瘤精确放疗星火计划(2019-N-11-35)。

摘　　要：目的观察伽玛刀治疗儿童颅内动静脉畸形(AVMs)的长期疗效,探讨影响畸形血管闭塞的相关因素。方法回顾性连续纳入1995年1月至2016年12月首都医科大学附属北京天坛医院伽玛刀中心治疗的儿童颅内AVMs患者(年龄≤16岁)279例。治疗采用的边缘处方剂量为12~25 Gy(中位数为17.0 Gy),中心处方剂量为19~50 Gy(中位数为32.7 Gy);治疗畸形血管的体积为0.1~30.2 cm3(中位数为1.7 cm3);54例患儿(19.4%)行多次伽玛刀治疗,其中35例因畸形残留重复治疗,19例行计划性分期治疗。随访患者的临床和影像学效果,分析影响AVMs闭塞的相关因素。结果279例患儿治疗后的随访时间为6~276个月(中位数为49个月),其中197例(70.6%)畸形血管闭塞,治疗后3、5、8年的闭塞率分别为33.5%(86/257)、69.4%(154/222)、81.1%(172/212);24例(8.6%)患儿治疗后发生与畸形相关的出血30例次,其中5例(1.8%)死亡;5例(1.8%)患儿发生永久性放射治疗相关的并发症,4例为神经功能障碍加重,1例为远期放射性囊变。单因素分析显示,与未闭塞组比较,闭塞组患儿的年龄较大,畸形体积<3 cm3、Spetzler-Martin分级1~3级、放射外科AVMs量表评分≤1.5分、边缘处方剂量≥17 Gy者所占的比率高,差异均有统计学意义(均P<0.05)。多因素Cox回归分析显示,边缘处方剂量≥17 Gy是畸形血管闭塞的影响因素(HR=1.42,95%CI:1.07~1.89,P=0.015)。结论伽玛刀治疗儿童颅内AVMs远期安全性、疗效均较好,尤其是对中小型AVMs的患儿;边缘处方剂量是影响AVMs远期疗效的主要因素。Objective To evaluate the long term outcome of gamma knife radiosurgery(GKS)for the treatment of arteriovenous malformations(AVMs)in children and to explore its relevant influencing factors.Methods We retrospectively studied 279 children with intracranial AVMs(age≤16 years)treated at the Gamma Knife Center of Beijing Tiantan Hospital,Capital Medical University from January 1995 to December 2016.The marginal prescription dose for treatment was 12-25 Gy(median:17.0 Gy),the central prescription dose was 19-50 Gy(median:32.7 Gy);the volume of the malformations treated was 0.1-30.2 cm3(median:1.7 cm3);54 children(19.4%)received multiple Gamma Knife treatments,of which 35 underwent repeated treatments due to residual lesion,and 19 underwent staged treatments as planned.The clinical and imaging effects of patients were followed up,and the relevant factors affecting the occlusion of AVMs were analyzed.Results The follow-up time of 279 children after treatment was 6 to 276 months(median:49 months),of which 197 cases(70.6%)had occlusion of AVMs.The occlusion rate at 3,5,and 8 years after treatment was 33.5%(86/257),69.4%(154/222),81.1%(172/212)respectively.Twenty-four children(8.6%)had 30 cases of AVM-related bleeding after treatment,and 5 cases(1.8%)died.Five cases(1.8%)had radiotherapy-related complications,4 cases had worsening neurological dysfunction,and 1 case had long-term radiation related cystic formation.Univariate analysis showed that compared with the non-occluded group,the children in the occluded group were older,the proportions of those with the lesion volume<3 cm3,Spetzler-Martin grade of 1 to 3,radiosurgery-based AVM score≤1.5,and marginal prescription dose≥17 Gy were higher,and the differences were statistically significant(all P<0.05).Multivariate Cox regression analysis showed that the marginal prescription dose≥17 Gy was an influencing factor for occlusion of AVMs(HR=1.42,95%CI:1.07-1.89,P=0.015).Conclusions The long-term safety and efficacy of radiosurgery for intracranial AVMs in children see

关 键 词：颅内动静脉畸形 放射外科手术 治疗结果 因素分析 统计学 远期 

分 类 号：R726.5[医药卫生—儿科]