小儿脑动静脉畸形(AVM)是发病的重要原因,但多模式疗法在治疗这些病变中的作用尚不清楚。
比较立体定向放射外科(SRS)和未栓塞治疗小儿AVM的结果。
我们回顾性评估了国际放射外科研究基金会小儿AVM数据库。AVM被分类,基于使用栓塞前(E+SRS)或缺乏(仅SRS)。在未调整和逆概率权重(IPW)调整模型中比较结果。良好的结局定义为无SRS后出血或永久性放射诱发变化(RIC)的闭塞。
E+SRS和仅SRS队列包括91名和448名患者,分别。在未调整的模型中,仅SRS队列的闭塞率更高(68.5%vs43.3%,<.001)和有利的结果(61.2%vs36.3%,P<.001),但有症状的RIC发生率较低(9.0%vs16.7%,P=.031)。2个队列中每个结果的IPW调整率相似。然而,在没有栓塞的情况下,3、5、8和10年的累积闭塞率仍然较高(46.3%,64.6%,72.6%,仅SRS为77.4%,为24.4%,37.2%,44.1%,E+SRS队列为48.7%,分别;SHR=0.449[0.238-0.846],P=.013)。
栓塞似乎可降低儿童AVMSRS后的累积闭塞率,而不影响治疗后出血或不良放射效应的风险,这与SRS前栓塞的常规使用相反。虽然在SRS之前可以考虑对高危血管结构特征进行血管内治疗,未来的研究有必要阐明其作用。
Pediatric brain arteriovenous malformations (AVMs) are a significant cause of morbidity but the role of multimodal therapy in the treatment of these lesions is not well understood.
To compare the outcomes of stereotactic radiosurgery (SRS) with and without prior embolization for pediatric AVMs.
We retrospectively evaluated the International Radiosurgery Research Foundation pediatric AVM database. AVMs were categorized, based on use of pre-embolization (E + SRS) or lack thereof (SRS-only). Outcomes were compared in unadjusted and inverse probability weight (IPW)-adjusted models. Favorable outcome was defined as
obliteration without post-SRS hemorrhage or permanent radiation-induced changes (RIC).
The E + SRS and SRS-only cohorts comprised 91 and 448 patients, respectively. In unadjusted models, the SRS-only cohort had higher rates of
obliteration (68.5% vs 43.3%, < .001) and favorable outcome (61.2% vs 36.3%, P < .001) but a lower rate of symptomatic RIC (9.0% vs 16.7%, P = .031). The IPW-adjusted rates of every outcome were similar between the 2 cohorts. However, cumulative
obliteration rates at 3, 5, 8, and 10 yr remained higher in the absence of prior embolization (46.3%, 64.6%, 72.6%, and 77.4% for SRS-only vs 24.4%, 37.2%, 44.1%, and 48.7% for E + SRS cohorts, respectively; SHR = 0.449 [0.238-0.846], P = .013).
Embolization appears to decrease cumulative
obliteration rates after SRS for pediatric AVMs without affecting the risk of post-treatment hemorrhage or adverse radiation effects arguing against the routine use of pre-SRS embolization. While endovascular therapy can be considered for occlusion of high-risk angioarchitectural features prior to SRS, future studies are necessary to clarify its role.