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首页> 外文期刊>Neurosurgery >Long-term Results after Stereotactic Radiosurgery for Patients with Cavernous Malformations.
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Long-term Results after Stereotactic Radiosurgery for Patients with Cavernous Malformations.

机译：立体定向放射外科手术治疗海绵状畸形后的长期结果。

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OBJECTIVE: Stereotactic radiosurgery has been used for patients with high-risk cavernous malformations of the brain. We performed radiosurgery for patients with symptomatic, imaging-confirmed hemorrhages for which resection was believed to be associated with high risk. This study examines the long-term hemorrhage rate after radiosurgery. METHODS: We reviewed data obtained before and after gamma knife radiosurgery on 82 patients treated between 1987 and 2000. Most patients had multiple hemorrhages from brainstem or diencephalic cavernous malformations. Follow-up data were examined to identify hemorrhages, and an overall hemorrhage rate was calculated. RESULTS: Observation before treatment averaged 4.33 years (range, 0.17-18 yr) for a total of 354 patient-years. During this period, 202 hemorrhages were observed, for an annual hemorrhage rate of 33.9%, excluding the first hemorrhage. Temporal clustering of hemorrhages was not significant. After radiosurgery, patient follow-up averaged 5 years (range, 0.42-12.08 yr), for a total of 401 patient-years. During this period, 19 hemorrhages were identified, 17 in the first 2 years posttreatment and 2 after 2 years. The annual hemorrhage rate was 12.3% per year for the first 2 years after radiosurgery, followed by 0.76% per year from Years 2 to 12. Eleven patients had new neurological symptoms without hemorrhage after radiosurgery (13.4%). The symptoms were minor in six of these patients and temporary in five. CONCLUSION: Radiosurgery confers a reduction in the risk of hemorrhage for high-risk cavernous malformations. Risk reduction, although in evidence during initial follow-up, is most pronounced after 2 years. Given the difficulty of identifying high-risk patients, treatment after one major hemorrhage should be considered in selected younger patients. Such a strategy warrants further investigation.
机译：目的：立体定向放射外科已被用于患有高风险的脑海绵状畸形的患者。我们对有症状，影像学确诊的出血患者进行了放射外科手术，据认为其切除与高风险相关。这项研究检查了放射外科手术后的长期出血率。方法：我们回顾了1987年至2000年间接受伽玛刀放射治疗的82例患者前后的数据。大多数患者因脑干或双脑海绵状畸形而出现多处出血。检查随访数据以识别出血，并计算总出血率。结果：治疗前的观察平均为4.33年（范围为0.17-18年），共354个患者年。在此期间，观察到202例出血，不包括第一次出血，年出血率为33.9％。出血的时间性聚类不明显。放射外科手术后，患者平均随访5年（范围0.42-12.08年），共401个患者年。在此期间，发现了19处出血，治疗后的前2年有17处出血，而2年后有2处出血。放射外科手术后的头两年的年出血率为每年12.3％，随后的2至12年每年为0.76％。放射外科手术后的11例患者有新的神经系统症状而无出血（13.4％）。这些患者中有六个是轻微症状，五个是暂时症状。结论：放射外科可以降低高风险海绵状畸形出血的风险。降低风险，尽管在最初的随访中很明显，但在2年后最为明显。鉴于难以识别高危患者，应在选定的年轻患者中考虑一次重大出血后的治疗。这种策略值得进一步研究。

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