Publication: Gamma-knife ile tedavi edilmiş arterio-venöz malformasyon olgularının ikinci yıl sonuçları
Abstract
Amaç: Gamma-Knife Işın Cerrahisi, arteriovenöz malformasyon tedavisinde, mikronöroşirürjikal girişime ve embolizasyona seçenek olarak, özellikle nidus çapı 40 mm'den az lezyonların tedavisinde, giderek artan bir yaygınlıkta kullanılmaktadır. Genel anestezi ve cerrahi müdahale gerektirmeyen bu yöntem, latent iyileşme döneminde damarda endotel proliferasyonu ile damar lümeninin tıkanması ve malformasyonun dolaşım dışı bırakılması ile etki gösterir. Bu çalışmanın amacı ikinci sene kontrolleri tamamlanan ilk 126 olguda Gamma-Knife tedavisinin etkinlik derecesini araştırmaktır. Yöntemler: Bu prospektif klinik çalışmada Marmara Üniversitesi Gamma-Knife Ünitesinde, radyocerrahi uygulanan AVM olgularından 2 yıllık anjiografik kontrolü bulunan ilk 126'sının klinik ve nöroradyolojik sonuçları sunulmuştur. Bulgular: 126 Olgunun 120' sinde (%95) AVM nidus boyutlarında azalma görülmüştür. AVM nidus boyutunda görülen değişiklik, 126 AVM olgusunun 103'ünde (%86) tam kapanma, 15'inde (%6) nidus hacminde %50-80 küçülme, 2'sinde (%1.6) ise yalnızca direne eden ven olarak saptanmıştır. Olguların 6'sında (%5) AVM nidus boyutunda değişiklik görülmemiştir.En az iki senelik izlemi olan 126 AVM olgusunun sonuçlarına göre, uygun olgu seçimi yapıldığında, GK'a bağlı komplikasyonlar ve GK sonrası latent dönemde kanama olasılığının toplamı tüm lokalizasyonlar göz önüne alındığında %7, mortalite oranı ise %0.8 olarak gerçekleşmiştir. Sonuç: GK'a uygun geometrik özelliklere sahip AVM'lerin tedavisi planlanırken %7 komplikasyon ve %1 mortalite oranları referans kabul edilmeli ve bu rakamların altında bir cerrahi komplikasyon oranı öngörüldüğünde mikrocerrahi seçilmelidir.
"Summary Aim: Gamma-Knife Radiosurgery (GKRS) has been used in gradually increasing insidence in the treatment of cerebral arteriovenous malformations (AVM), having nidus diameter less than 40mm. This treatment, which avoids drawbacks of surgical invasiveness and general anesthesia, cures the AVM by resulting in obliteration of AVM caused by proliferation of endothelial cells. In this report, the effectiveness of GKRS performed by Marmara University Gamma-Knife Center in the first 126 AVM patients, who completed 2 year follow-up, is presented. Material and Method: In this prospective study, clinical and angiographic results, concluded in the end of 2nd year follow-up of AVM patients are presented. All patients has been treated by GKRS at Marmara University, Istanbul, Turkey. Results: In 95% (120 / 126) of all patients, reduction in nidus size was detected. In 86% (103 / 126), reduction in nidus size reached to complete obliteration. In 6% (15 / 126) a 50-80% reduction in nidal volume and in 1.6% (2 / 126) detection of only a venous drainage but the nidus were concluded. In the end of two years 6 patients (5%) revealed no change in the nidal volume. The combined rate of complications plus hemorrhage in the first 2 years was calculated to be 7%, and mortality rate in the same period was 0.8%. Conclusion: It is concluded that in the management of AVM's those are geometrically suitable for GKRS, microsurgery should be the treatment of choice instead of GKRS only if the expected surgical morbidity and mortality are less than 7% and 1% respectively."
"Summary Aim: Gamma-Knife Radiosurgery (GKRS) has been used in gradually increasing insidence in the treatment of cerebral arteriovenous malformations (AVM), having nidus diameter less than 40mm. This treatment, which avoids drawbacks of surgical invasiveness and general anesthesia, cures the AVM by resulting in obliteration of AVM caused by proliferation of endothelial cells. In this report, the effectiveness of GKRS performed by Marmara University Gamma-Knife Center in the first 126 AVM patients, who completed 2 year follow-up, is presented. Material and Method: In this prospective study, clinical and angiographic results, concluded in the end of 2nd year follow-up of AVM patients are presented. All patients has been treated by GKRS at Marmara University, Istanbul, Turkey. Results: In 95% (120 / 126) of all patients, reduction in nidus size was detected. In 86% (103 / 126), reduction in nidus size reached to complete obliteration. In 6% (15 / 126) a 50-80% reduction in nidal volume and in 1.6% (2 / 126) detection of only a venous drainage but the nidus were concluded. In the end of two years 6 patients (5%) revealed no change in the nidal volume. The combined rate of complications plus hemorrhage in the first 2 years was calculated to be 7%, and mortality rate in the same period was 0.8%. Conclusion: It is concluded that in the management of AVM's those are geometrically suitable for GKRS, microsurgery should be the treatment of choice instead of GKRS only if the expected surgical morbidity and mortality are less than 7% and 1% respectively."