| Background:Cerebral arteriovenous malformation is a kind of cerebrovascular disease,which can occur in the brain and spinal cord.The arterial blood flow does not pass through the capillary system and flows directly into the venous system,resulting in a significant increase in blood flow,and the blood vessels are tortuous and easy to rupture.According to reports,the estimated detection rate of BAVM is about 1/100000,accounting for 1%of all stroke people.At present,the pathogenesis of BAVM is still inconclusive.In the past,most scholars thought it was a congenital lesion caused by abnormal embryonic development.Later,many studies have shown that BAVM can also be acquired,and its occurrence and development is related to many factors,including basic fibroblast growth factor[2],hepatocyte growth factor,vascular endothelial growth factor(vascular endothelial growth factor,VEGF),angiopoietin and its receptor and so on.The diagnostic methods of BAVM mainly include CT,MRI and DSA,and DSA is the "gold standard" for diagnosis.In recent years,with the popularization of imaging technology,the utilization rate of the three technologies has increased,and the detection rate of BAVM has increased.The clinical symptoms were bleeding,epilepsy,headache and neurological dysfunction according to the frequency of occurrence.The treatment of BAVM includes microsurgical resection,endovascular embolization and radiosurgery.It is generally believed that for the lesions with superficial location and direct access to surgery,surgical resection is recommended first,which can achieve a fundamental cure.However,there is no unified opinion on the lesions with deep location,large size and located in important functional areas of the brain.In recent years,with the development of stereotactic radiosurgery,gamma knife radiosurgery(Gama knife radio surgery,GKS)has been paid more and more attention in the treatment of BAVM,which has the advantages of high precision,minimally invasive and less complications.A number of studies have confirmed the efficacy of GKS,but the related studies are not perfect,in order to further explore the prognosis and influencing factors of GKS in patients with BAVM.A retrospective study was conducted on 86 patients who received GKS in the Department of Neurosurgery of the second Hospital of Shandong University from May 2016 to May 2022.The effects of different factors on the prognosis were analyzed and a clinical predictive model was established.Purpose:Analysis of the efficacy and prognostic factors of gamma knife radiosurgery in the treatment of cerebral arteriovenous malformations.Method:A total of 86 patients who were treated in the Department of Neurosurgery of the second Hospital of Shandong University and treated in the Gamma knife treatment Center with complete follow-up data from May 2016 to May 2022 were included in the study.The age of the patients ranged from 4 to 73 years old(mean 28.67±16.33 years).Among them,51(59.30%)patients presented with intracranial hemorrhage,17(19.77%)patients with epilepsy,12(13.95%)patients with headache and 3(3.49%)patients with neurological impairment.8(9.30%)patients had been treated by operation,39(45.35%)had been treated by interventional embolization,and 39(45.35%)had been treated with gamma knife.The lesion volume was 0.55-36.67cm3(median volume 3.31 cm3),marginal dose 12-22.5Gy(median dose 16Gy),central dose 24-50Gy(median dose 35.60Gy).In the Pittsburgh radiosurgery AVM score,42 patients(48.84%)scored less than 1,19 patients(22.09%)scored between 1.01 and 1.50,14 patients(16.28%)scored between 1.51 and 2.00,and 11 patients(12.79%)scored more than 2.The sex,age,first symptom,lesion diameter,volume,marginal dose,central dose,Pittsburgh radiosurgery AVM score,proton knife radiosurgery AVM score(Proton beam stereotactic radiosurgery,PSRS),Virginia score(Virginia Radiosurgery AVM Scale,VRAS),Heidelberg score and Spetzler-Martin score were analyzed by univariate and multivariate logistics analysis.Result:All patients were followed up for 6 to 65 months(median follow-up time was 16 months).30(34.88%)patients were occluded,of which 6(6.98%)were confirmed by DSA and 24(27.91%)were confirmed by MRI.The lesions of the other 52 patients(60.47%)were reduced.There was no change in 4(4.65%)patients.Adverse reactions of brain edema occurred in 2(2.33%)patients after operation.There were no patients with bleeding after treatment.17(19.77%)patients with epilepsy were relieved in varying degrees,including 10(11.63%)patients with Engel I grade,5(5.81%)patients with Engel II grade and 2(2.33%)patients with Engel III grade.Univariate analysis showed that there were significant differences in age(2=7.738,P=0.005),Pittsburgh radiosurgery AVM score(2=10.308,P=0.001),proton knife radiosurgery score(2=4.919,P=0.027),diameter(2=4.754,P=0.029),volume(2=6.439,P=0.011),bleeding(2=12.074,P=0.001),surgical history(2=5.015,P=0.025)and embolization history(2=3.904,P=0.048).No single statistical difference was found in the multivariate analysis of the above factors.Further Logistic analysis found that volume and age as a whole,hemorrhage and Pittsburgh radiosurgery AVM score as a whole were significant prognostic factors.Clinical predictive models were established and internal tests were carried out.Discussion:This study confirmed that gamma knife radiosurgery is safe and effective in the treatment of cerebral arteriovenous malformations.Age,bleeding,lesion volume and RBAS score were independent risk predictors of vascular occlusion after gamma knife treatment of cerebral arteriovenous malformations.Older age,no bleeding,larger volume and high RBAS score were associated with poor prognosis.Through the above-mentioned feature combination model,we can more accurately predict the outcome of GKS treatment.Previous history of surgery and/or embolization can reduce the difficulty and risk of adverse consequences of GKS treatment. |
PDF Full Text Request