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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 To retrospectively evaluate the therapeutic effect of gamma knife on brainstemarteriovenous malformation (BAVM). Methods From March 2003 to April 2009, our hospital applied domestic MASEP head gamma knife to treat 30 cases of brainstem AVM. The average age of patients was 23.9 years (17 to 38 years old). 22 (73%) cases of patients with the first symptom of hemangiomas bleeding. Vascular malformations: 18 cases of midbrain, pontine in 9 cases, 3 cases of medulla oblongata. AVM volume average of 3.5 ml (0.5 ~ 7 ml). MRI and digital subtraction angiography (MRI + DSA) examination and co-location. Marginal measurement of 12 ~ 18Gy, an average of 15.5Gy, 45% to 50% (average 48.5%) of the isodose curve wrapped brainstem AVM lesions. After a year of treatment by MRI and DSA review, continuous review for 3 years, such as the vascular neoplasia is not ideal, the line re-treatment. Results The follow-up time ranged from 12 to 64 months with an average of 28 months. Gamma knife treatment of brainstem AVM has a good occlusion rate when using lower dose; AVM occlusion rate of brainstem is related to its volume and edge measurement. Follow-up after 3 years: The occlusion rate of brain stem in AVM was 53.3% and the annual bleeding rate was 2.3%. Most patients after gamma knife treatment disappeared or improved clinical symptoms, no neurological dysfunction. Conclusion Gamma knife is a safe, effective and low-invasive method for the treatment of AVM in brainstem. It can be used as the first choice of AVM in brainstem.