2. ガンマナイフの立場から(脳血管障害の非観血的治療法,<シリーズ>血管・血圧系(5))

概要

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We have 3 kinds of treatment strategy for arteriovenous malformation (AVM) as follows; 1) surgical removal, 2) endovascular surgery, and 3) radiosurgery (gamma knife surgery: GKS). We have to consider how to use among of them and their combination for each patient. GKS is the least invasive treatment for AVM, and it takes only one day to perform. As the clinical results, lately, complete occlusion of AVM was observed in 70% after 2-3 years of treatment. Most of the patients with incomplete occlusion had chance to be cured by second GKS, targeted to the residual part of AVM. For larger volume of AVM, we should consider "staged radiosurgery" initially to avoid excessive irradiation dose and energy for target lesion including surround normal brain tissue. Rate of (re) bleeding of AVM after treatment was 2-4% per year. There are not few reports of the cases who developed to severe cerebral swelling and cyst formation within long term follow-up. We should evaluate and reconsider the clinical results, and had better to establish new concept to treat AVM to obtain better results, especially for intractable AVM.
東京女子医科大学の論文