【摘要】 目的　评估立体定向放射外科治疗硬脑膜动静脉瘘的安全性和有效性。　方法　采 用伽玛刀治疗硬脑膜动静脉瘘16例,其中单纯伽玛刀治疗7例,经动脉途径栓塞或手术治疗后再 行伽玛刀治疗9例。根据Congard分型,硬脑膜动静脉瘘Ⅰ型4例,Ⅱa型5例,Ⅱa+b型3例, Ⅲ型3例,Ⅳ型1例。靶点边缘剂量16～20Gy,平均18Gy,靶点边缘被50%～70%等剂量曲线 所包含。所有患者均获得随访,随访时间为5～108个月。　结果　14例患者术后症状消失,2例部 分改善。12例MRI或造影证实瘘口完全或近全闭塞,4例部分闭塞。无放射治疗导致的并发症。　 结论　立体定向放射外科是一种治疗硬脑膜动静脉瘘安全、有效的方法。对侵袭型硬脑膜动静脉瘘 且伴有广泛皮质静脉引流的患者,血管内治疗或手术治疗结合放射外科是一种有效的治疗模式。更多还原

【Abstract】 Objective To investigate the efficacy and safety of radiosurgery for the treatment of dural arteriovenous fistulas (DAVF). Methods 16 patients with DAVF who were treated by gamma knife radiosurgery were enrolled in the study. 9 patients had been treated with embolization and/or surgery previously, whereas 7 patients underwent radiosurgery alone. According to the Cognard classification, DAVF was classified to Type I in 4 cases, Type IIa in 5 cases , Type IIa+b in 3 cases, Type Ⅲ in 3 cases and TypeⅣ in 1 case. The average prescribed margin target doses were 18 Gy (ranging from 16 to 20 Gy). The targets were covered by 50% to 70% isodose levels. All patients were available for follow-up review. Results Of the 16 patients, 14 cases were cured of their symptoms and 2 cases were partial improved. Follow-up magnetic resonance imaging and/or angiography showed that total or subtotal obliteration of the DAVF was found in 12 patients and partial obliteration was found in 4 cases. There was no neurological complication related to the radiosurgery. Conclusion Stereotactic radiosurgery provides a safe and effective option for the treatment of the DAVF. For some aggressive DAVF with extensive retrograde cortical venous drainage, a combination of endovascular embolization and surgery may be necessary.更多还原