当前位置： SCI文献检索 > JOURNAL OF NEUROSURGERY期刊下所有文献 > Stereotactic radiosurgery for arteriovenous malformations, Part 5: management of brainstem arteriovenous malformations.

Stereotactic radiosurgery for arteriovenous malformations, Part 5: management of brainstem arteriovenous malformations.

Abstract：

OBJECT:In this paper, the authors' goal was to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the medulla, pons, and midbrain. METHODS:Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 67 patients had AVMs in the brainstem. In this series, 51 patients (76%) had a prior hemorrhage. The median target volume was 1.4 cm(3) (range 0.1-13.4 cm(3)). The median margin dose was 20 Gy (range 14-25.6 Gy). RESULTS:Obliteration of the AVMs was eventually documented in 35 patients at a median follow-up of 73 months (range 6-269 months). The actuarial rates of documentation of total obliteration were 41%, 70%, 70%, and 76% at 3, 4, 5, and 10 years, respectively. Higher rates of AVM obliteration were associated only with a higher margin dose. Four patients (6%) suffered a hemorrhage during the latency period, and 2 patients died. The rate of AVM hemorrhage after SRS was 3.0%, 3.0%, and 5.8% at 1, 5, and 10 years, respectively. The overall annual hemorrhage rate was 1.9%. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 7 patients (10%) after SRS, and a delayed cyst developed in 2 patients (3%). One patient died at an outside institution with symptoms of AREs and unrecognized hydrocephalus. Higher 12-Gy volumes and higher Spetzler-Martin grades were associated with a higher risk of symptomatic AREs. Ten of 22 patients who had ocular dysfunction before SRS had improvement, 9 were unchanged, and 3 were worse due to AREs. Eight of 14 patients who had hemiparesis before SRS improved, 5 were unchanged, and 1 was worse. CONCLUSIONS:Although hemorrhage after obliteration did not occur in this series, patients remained at risk during the latency interval until obliteration occurred. Thirty-eight percent of the patients who had neurological deficits due to prior hemorrhage improved. Higher dose delivery in association with conformal and highly selective SRS is required for safe and effective radiosurgery.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Kano H,Kondziolka D,Flickinger JC,Yang HC,Flannery TJ,Niranjan A,Novotny J Jr,Lunsford LD

doi

10.3171/2011.9.JNS11176

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

44-53

issue

eissn

0022-3085

issn

1933-0693

journal_volume

116

pub_type

杂志文章

在线工具

Stereotactic radiosurgery for arteriovenous malformations, Part 5: management of brainstem arteriovenous malformations.