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首页> 外文期刊>Neurosurgery >Management of cysts arising after radiosurgery to treat intracranial arteriovenous malformations.
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Management of cysts arising after radiosurgery to treat intracranial arteriovenous malformations.

机译：放射外科治疗颅内动静脉畸形后出现的囊肿的处理。

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OBJECTIVE: The proper treatment for patients with cyst formation after arteriovenous malformation radiosurgery is unknown. METHODS: The treatment of six patients who developed cysts after arteriovenous malformation radiosurgery is described. Four patients had undergone gamma knife radiosurgery (two patients developed cysts after repeat procedures), and two patients had undergone linear accelerator-based radiosurgery. The median prescription isodose volume at the time of the first radiosurgical procedure was 13.2 cm3 (range, 8.0-28.7 cm3). RESULTS: The cysts were discovered a median of 48 months (range, 24-89 mo) after radiosurgery. Three patients were originally without symptoms, and observation with serial imaging was performed; two of those patients developed symptoms 13 and 40 months later, whereas one patient has remained without symptoms for 51 months. Initial treatments for patients with symptomatic cysts included cyst aspiration (n = 3) and placement of a cystoperitoneal shunt (CPS) (n = 2). The median cyst volume was 14 cm3 (range, 4-63 cm3). Cyst recurrence occurred within 2 months for patients who underwent aspiration alone, necessitating placement of a CPS. Shunt placement eliminated the cysts for four patients, at a median follow-up time of 16 months (range, 9-27 mo). One patient's cyst persisted despite CPS placement, and cyst excision was performed. No morbidity occurred with any of the cyst treatments. CONCLUSION: Cyst formation after arteriovenous malformation radiosurgery may occur many years after the procedure. Although most symptomatic cysts can be effectively treated with CPSs, cyst excision may be necessary if the mass effect is not relieved with the less invasive approach.
机译：目的：动静脉畸形放疗后囊肿形成的正确治疗方法尚不清楚。方法：描述了对6例动静脉畸形放射外科手术后发生囊肿的患者的治疗方法。四名患者接受了伽玛刀放射外科手术（两名患者在重复手术后出现了囊肿），两名患者接受了基于线性加速器的放射外科手术。第一次放射外科手术时处方中的等剂量碘伏量为13.2 cm3（范围为8.0-28.7 cm3）。结果：放射外科手术后发现囊肿的中位数为48个月（范围24-89 mo）。 3例患者最初无症状，并进行了连续影像学观察;这些患者中有两名在13和40个月后出现症状，而一名患者在51个月内未出现任何症状。有症状性囊肿患者的初始治疗包括囊肿抽吸术（n = 3）和放置膀胱腹膜分流术（CPS）（n = 2）。中位囊肿体积为14 cm3（范围为4-63 cm3）。仅接受抽吸的患者在2个月内发生囊肿复发，需要放置CPS。分流放置消除了四名患者的囊肿，中位随访时间为16个月（范围9-27 mo）。尽管放置了CPS，一名患者的囊肿仍然存在，并进行了囊肿切除术。任何囊肿治疗均无发病。结论：动静脉畸形外科手术后多年可能会形成囊肿。尽管大多数症状性囊肿可以用CPS有效治疗，但如果采用微创方法不能减轻肿块的影响，则可能需要切除囊肿。

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