Santral yerleşimli arteriyovenöz malformasyonlar için gamma knife radyocerrahisi-tek merkez deneyimi

Year 2023, , 162 - 167, 05.04.2023

Burak Karaaslan

https://doi.org/10.31362/patd.1228220

Abstract

Amaç: Bazal gangliyon, beyin sapı ve talamik yerleşimli arteriovenöz malformasyonlar (AVM) kritik bölgede yerleşmiş kompleks damar anomalileridir. Bu santral yerleşimli lezyonların tedavisi yüksek morbidite ve mortalite riski taşır. Çalışmamızda bazal ganglion, beyin sapı ve talamik yerleşimli AVM nedeniyle kliniğimizde gamma knife radyocerrahi uygulanmış hastaların sonuçları retrospektif olarak incelenmesi amaçlandı.
Gereç ve yöntem: Mayıs 2005-Aralık 2020 tarihleri arasında Gazi Üniversitesi Gamma Knife Ünitesinde tedavi edilmiş bazal gangliyon, talamus ve beyin sapı yerleşimli AVM hastalarının sonuçları incelendi.
Bulgular: Mayıs 2005-Aralık 2020 tarihleri arasında Gazi Üniversitesi Gamma Knife Ünitesinde toplam 859 intrakraniyal AVM hastası tedavi edildi. Bazal ganglion, beyin sapı ve talamik lokalizasyonu olan 73 hasta çalışmaya dahil edildi. Çalışmamıza dahil edilen toplam 73 hastanın 14'ü (%19,2) bazal ganglionda, 13'ü (%17,8) beyin sapında ve 46'sı (%63) talamik bölgede yer alıyordu. Ortalama AVM hacmi 4565,54 mm3 olarak hesaplandı. Gamma knife cerrahisi tedavisinden önce embolizasyon uygulanan hastaların oranının %19.2’idi. SRS sonrası AVM'lerin ortalama tam kapanma sürelerinin 38,4 aydı. AVM hacmi, Spetzler Martin derecelendirme ölçeği, nidus tipi, cinsiyet ve önceki embolizasyon ile kapanma oranı arasında istatistiksel olarak anlamlı ilişkisi saptanmadı (p>0.05).
Sonuç: GKS günümüzde serebral AVM tedavisinde kullanılan etkin bir tedavi yöntemidir. GKS özellikle tedavisi yüksek morbidite ve mortalite riski içeren santral yerleşimli AVM tedavisinde başarılı sonuçları ile öncelikli tercih edilen tedavi yöntemlerindendir.

Keywords

Arteriyovenöz malformasyonlar, stereotaktik radyocerrahi, Gamma Knife radyocerrahisi, bazal ganglionlar, talamus

Gamma knife radiosurgery for central arteriovenous malformations: a single-center experience

Abstract

Purpose: Arteriovenous malformations with basal ganglia, brainstem, and thalamic locations represent complex vessel anomalies with critical areas. Treatment of these central lesions is related to high morbidity and mortality rates. This retrospective study aims to examine the results of our clinic's patients with basal ganglia, brainstem, and thalamic arteriovenous malformations remedied with gamma knife radiosurgery (GKS).
Method: The results of patients with basal ganglia, thalamus, and brainstem located AVM who underwent GKS from May 2005-December 2020 were analyzed in the Gazi University Gamma Knife Unit.
Results: A total of 859 patients with intracranial AVM were treated at the Gamma Knife Unit of the Gazi University Neurosurgery Clinic between May 2005-December 2020. Seventy-three patients with basal ganglia, brainstem, and thalamic locations were recorded. In a total of 73 patients who were included in the study, the lesion was located in the basal ganglia in 14 (19.2%), the brainstem in 13 (17.8%), and the thalamic region in 46 (63%) patients. The mean volume of AVMs was 4565,54 mm3. The patients who underwent embolization before gamma knife surgery treatment were found to be 19.2%. The mean of AVMs' obliteration time after SRS is 38.4 months. We detected that there was no significant statistical rate relationship between obliteration rate and AVMs volume, Spetzler - Martin Grading Scale, nidus type, gender, and prior embolization (p>0.05).
Conclusions: GKS is one of the effective choice treatment methods used for cerebral AVMs today. Furthermore, it has been accepted as the first choice treatment method, especially in central AVMs, which are risky in terms of mortality and morbidity, and also with good outcomes.

Keywords

Arteriovenous malformations, stereotactic radiosurgery, gamma knife radiosurgery, basal ganglia, thalamus

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