儿童及青少年颅内动静脉畸形的伽玛刀放射治疗。

E M Altschuler, L D Lunsford, R J Coffey, D J Bissonette, J C Flickinger
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引用次数: 71

摘要

18名儿童或青少年颅内动静脉畸形(AVM)接受立体定向放射手术,使用第一个北美伽玛刀。从1987年8月开始,这种封闭颅骨的单次治疗方法,利用201束电离伽马射线照射,作为显微手术切除的替代方法,用于这些选定的患者(年龄34个月至18岁,平均12.3岁)。随访7 ~ 19个月,无明显围手术期并发症发生,无患者复发或死亡。使用计算机断层扫描(CT)和磁共振成像(MRI)来监测对治疗的反应,并确定术后何时需要进行血管造影。治疗1年后脑血管造影检查的7例avm中,3例完全消失;另外3例明显较小,预计在治疗后2年内完全消除。随访CT或MRI证实3例患者治疗体积周围有衰减或提示水肿的信号改变;我先前存在的神经缺陷有过一过性恶化。虽然这项新技术目前在美国仍需要更长远的眼光,但我们相信伽玛刀立体定向放射手术是一种安全有效的方法,可以消除被认为风险太大而不能进行显微手术切除的动静脉畸形。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Gamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence.

Eighteen children or adolescents with intracranial arteriovenous malformations (AVM) underwent stereotactic radiosurgery using the first North American gamma knife. This closed-skull, single-treatment therapy, utilizing 201 ionizing beams of gamma-irradiation, was used as an alternative to microsurgical removal in these selected patients (aged 34 months to 18 years, mean 12.3 years) beginning in August 1987. No significant perioperative morbidity occurred, and no patient rebled or died in the follow-up interval ranging between 7 and 19 months. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to monitor the response to treatment and to determine when postoperative angiography was indicated. Of seven AVMs examined with cerebral angiography 1 year after treatment, three were completely obliterated; three others were significantly smaller, and their complete obliteration is anticipated by 2 years after treatment. Follow-up CT or MRI confirmed attenuation or signal changes suggestive of edema surrounding the treatment volume in 3 patients; 1 had transient worsening of a preexisting neurological deficit. Although a more long-term perspective is still required for this new technology now available in the United States, we believe that gamma knife stereotactic radiosurgery is a safe and effective method to obliterate AVM deemed too risky for microsurgical removal.

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