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Gamma Unitによる脳動静脈奇形の治療: 治療不成功例の検討

脳卒中の外科, 1992, Vol.20(5), pp.347-354

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  • Title:
    Gamma Unitによる脳動静脈奇形の治療: 治療不成功例の検討
  • Author: 山本, 昌昭 ; 神保, 実 ; 井出, 光信 ; 田中, 典子 ; Yamamoto, Masaaki ; Jimbo, Minoru ; Ide, Mitsunobu ; Tanaka, Noriko ; Karlsson, Bengt ; Lindquist, Christer ; Steiner, Ladislau
  • Found In: 脳卒中の外科, 1992, Vol.20(5), pp.347-354
  • Subjects: Arteriovenous Malformation ; Radiosurgery ; Long-Term Follow-Up ; Unsuccessful Treatment
  • Language: Japanese
  • Description: 脳動静脈奇形(AVM)に対しgamma unitによる治療が行われ2年以上を経過した25例のうち, 治療が不満足な結果に終っている8例を報告し, 治療不成功の要因を検討した. 症例の内訳は, 初回照射治療により病巣の完全閉塞が得られず, 再照射を行った2例. 照射後の脳血管撮影では部分閉塞しか確認されていないにもかからわず, その後の検査が患者の不承諾のため行われていない3例. 完全閉塞が確認されたが, 放射線障害を残したものと, 脳血管撮影後に合併症で失ったもの各1例. 残るは,患者の承諾が得られないため, 照射後の脳血管撮影が全く行われていない1例である. 治療が不成功となった要因としては (3例では複数の要因が考えられた), 適応判断に問題があったもの3例, 術中の脳血管撮影で病巣が完全に描出されなかったもの1例, 照射計画に問題があったと考えられたもの3例, および術後のfoilow-upに問題があったもの4例であった. AVMに対するgammaunit治療を成功裡に行うには, 的確な適応判断と正確な治療が肝要なことは既に周知のごとくである. それに加え, 照射後の綿密な追跡を長期にわたり行うことの重要性を強調したい.
    Among 25 patients with cerebral arteriovenous malformation (AVM), who were followed for more than two years after gamma unit radiosurgery, treatment outcomes were unsatisfactory in eight patients. The patients consisted of two cases whose AVMs were angiographically shown to have not been completely obliterated following the initial treatment and were therefore reirradiated, three who refused further angiographic examination despite only partial obliteration of the nidus having been obtained, and two cases of complete nidus obliteration with radiation-related morbidity or with angiography-related mortality. In the one remaining case, no neurodiagnostic imaging studies have thus far been performed because the patient has refused them. Factors which could have contributed to unsatisfactory treatment outcomes in these eight cases were as follows (three patients had multiple factors): 1) inappropriate patient selection criteria for this procedure (three cases), 2) poor delineation of the AVM on stereotactic angiography (one case), 3) imprecise delivery of the radiation dose due to incorrect dose planning (three cases), and 4) inadequate follow-up after radiosurgery (four cases). Successful radiosurgical treatment requires appropriate patient selection and precise delivery of the radiation dose to the target, as is well known. Furthermore, we emphasize that meticulous long-term follow-up is essential in successfully managing all radiosurgically treated AVM patients.
  • Identifier: ISSN: 0914-5508 ; DOI: 10.2335/scs1987.20.5_347

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