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

Yıl 2023, Cilt: 16 Sayı: 2, 162 - 167, 05.04.2023

Burak Karaaslan

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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Crawford PM, West CR, Chadwick DW, Shaw MD. Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 1986;49:1-10. https://doi.org/10.1136/jnnp.49.1.1
• 2. Andrade Souza YM, Zadeh G, Scora D, Tsao MN, Schwartz ML. Radiosurgery for basal ganglia, internal capsule, and thalamus arteriovenous malformation: clinical outcome. Neurosurgery 2005;56:56-63;discussion63-64. https://doi.org/10.1227/01.neu.0000145797.35968.ed
• 3. Gross BA, Duckworth EAM, Getch CC, Bendok BR, Batjer HH. Challenging traditional beliefs: microsurgery for arteriovenous malformations of the basal ganglia and thalamus. Neurosurgery 2008;63:393-410;discussion 410-411. https://doi.org/10.1227/01.NEU.0000316424.47673.03 4. Kurita H, Kawamoto S, Sasaki T, et al. Results of radiosurgery for brain stem arteriovenous malformations. J Neurol Neurosurg Psychiatry 2000;68:563-570. https://doi.org/10.1136/jnnp.68.5.563
• 5. Sheehan J. Radiosurgery. J Neurosurg 2012;116:1-2;discussion9-10. https://doi.org/10.3171/2011.6.JNS11844
• 6. Nicolato A, Foroni R, Crocco A, et al. Gamma knife radiosurgery in the management of arteriovenous malformations of the Basal Ganglia region of the brain. Minim Invasive Neurosurg 2002;45:211-223. https://doi.org/10.1055/s-2002-36200
• 7. Sasaki T, Kurita H, Saito I, et al. Arteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases. J Neurosurg 1998;88:285-292. https://doi.org/10.3171/jns.1998.88.2.0285
• 8. Miyasaka Y, Yada K, Ohwada T, Kitahara T, Kurata A, Irikura K. An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations. J Neurosurg 1992;76:239-243. https://doi.org/10.3171/jns.1992.76.2.0239
• 9. Stereotactic radiosurgery for arteriovenous malformations, Part 4: management of basal ganglia and thalamus arteriovenous malformations. Available at: https://pubmed.ncbi.nlm.nih.gov/22077451/. Accessed Dec 21, 2022
• 10. Crocco A. Arteriovenous malformations in the basal ganglia region: Gamma Knife radiosurgery as first choice treatment in selected cases. J Neurosurg Sci 2002;46:43-54.
• 11. de Oliveira E, Tedeschi H, Siqueira MG, Ono M, Rhoton AL. Arteriovenous malformations of the basal ganglia region: rationale for surgical management. Acta Neurochir (Wien) 1997;139:487-506. https://doi.org/10.1007/BF02750990
• 12. Ogilvy CS, Stieg PE, Awad I, et al. Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Circulation 2001;103:2644-2657. https://doi.org/10.1161/01.cir.103.21.2644
• 13. Paulsen RD, Steinberg GK, Norbash AM, Marcellus ML, Marks MP. Embolization of basal ganglia and thalamic arteriovenous malformations. Neurosurgery 1999;44:991-996;discussion996-997. https://doi.org/10.1097/00006123-199905000-00031
• 14. Hurst RW, Berenstein A, Kupersmith MJ, Madrid M, Flamm ES. Deep central arteriovenous malformations of the brain: the role of endovascular treatment. J Neurosurg 1995;82:190-195. https://doi.org/10.3171/jns.1995.82.2.0190
• 15. Koga T, Shin M, Maruyama K, Terahara A, Saito N. Long-term outcomes of stereotactic radiosurgery for arteriovenous malformations in the thalamus. Neurosurgery 2010;67:398-403. https://doi.org/10.1227/01.NEU.0000371989.90956.6F
• 16. Pollock BE, Gorman DA, Brown PD. Radiosurgery for arteriovenous malformations of the basal ganglia, thalamus, and brainstem. J Neurosurg 2004;100:210-214. https://doi.org/10.3171/jns.2004.100.2.0210
• 17. Yakar F, Egemen E, Dere ÜA, et al. The effectiveness of gamma knife radiosurgery for the management of residual high-grade gliomas: a single institutional study. J Clin Neurosci 2022;95:159-163. https://doi.org/10.1016/j.jocn.2021.12.015
• 18. Cohen Inbar O, Starke RM, Lee CC, et al. Stereotactic Radiosurgery for Brainstem Arteriovenous Malformations: A Multicenter Study. Neurosurgery 2017;81:910-920. https://doi.org/10.1093/neuros/nyx189
• 19. Choi HJ, Choi SK, Lim YJ. Radiosurgical techniques and clinical outcomes of gamma knife radiosurgery for brainstem arteriovenous malformations. J Korean Neurosurg Soc 2012;52:534-540. https://doi.org/10.3340/jkns.2012.52.6.534
• 20. Smyth MD, Sneed PK, Ciricillo SF, et al. Stereotactic radiosurgery for pediatric intracranial arteriovenous malformations: the University of California at San Francisco experience. J Neurosurg 2002;97:48-55. https://doi.org/10.3171/jns.2002.97.1.0048
• 21. Friedman WA, Bova FJ, Mendenhall WM. Linear accelerator radiosurgery for arteriovenous malformations: the relationship of size to outcome. J Neurosurg 1995;82:180-189. https://doi.org/10.3171/jns.1995.82.2.0180