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논문 기본 정보

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학술저널
저자정보
Myeong Ho Sung (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Jeong Sang Soon (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Kim Jung Hoon (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Lee Jae Meen (Department of Neurosurgery, Pusan National University Hospital, Busan, Korea.) Park Kwang Hyon (Department of Neurosurgery, Chungnam National University Hospital, Sejong, Korea.) Park Kawngwoo (Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.) Park Hyun Joo (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Park Hye Ran (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.) Yoon Byung Woo (Department of Internal Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwnagmyeong, Korea.) Hahn Seokyung (Department of Human Systems Medicine, Medical Statistics Laboratory, Seoul National University College of Medicine, Seoul, Korea.) Lee Eun Jung (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Kim Jin Wook (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Chung Hyun Tai (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Kim Dong Gyu (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Paek Sun Ha (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.39 No.29
발행연도
2024.7
수록면
1 - 13 (13page)
DOI
10.3346/jkms.2024.39.e217

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초록· 키워드

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Background: Treatment for large (> 10 mL) arteriovenous malformations (AVMs) remains highly challenging. This study evaluated long-term effect of time-staged gamma knife radiosurgery (GKS) for large AVMs. Methods: For patients with large AVMs treated by time-staged GKS over 10 years, timestaged GKS was repeated every three years targeting the entire nidus if total obliteration was not achieved. Obliteration rate and post-GKS complications were assessed based on 10 mL volume interval of AVMs. Prognostic factors for these outcomes were evaluated using Cox regression analysis. Results: Ninety-six patients were analyzed. For AVMs in the 10–20 mL subgroup, a dose ≥ 13.5Gy yielded higher obliteration rate in the first GKS. In the 20–30 mL subgroup, a second GKS significantly boosted obliteration. AVMs > 30 mL did not achieve any obliteration with the first GKS. Among 35 (36.4%) cases lost to follow-up, 7 (7.2%) were lost due to GKS complications. Kaplan-Meier analysis showed that each subgroup needed different time for achieving 50% favorable obliteration outcome rate: 3.5, 6.5, and 8.2 years for 10–20 mL, 20–30 mL, and > 30 mL subgroup, respectively. Total obliteration rate calculated by intention-to-treat method: 73%, 51.7%, 35.7%, respectively, 61.5% overall. Post-GKS hemorrhage and chronic encapsulated expanding hematoma (CEEH) occurred in 13.5% and 8.3% of cases, respectively. Two patients died. Dose and volume were significant prognostic factors for obliteration. Initial AVM volume was a significant prognostic factor of post-GKS hemorrhage and CEEH. Conclusion: Time-staged GKS for large AVMs less than 30 mL has highly favorable long-term outcome and a tolerable complication rate.
#Time-Staged Gamma Knife Radiosurgery #Large Arteriovenous Malformation #Long-Term Outcome #Minimal Residual Shunt #Chronic Encapsulated Expanding Hematoma

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