ハヤシ　モトヒロ   HAYASHI Motohiro   林　基弘    所属   医学部 医学科（東京女子医科大学病院）    職種   教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Combined management of intracranial arteriovenous malformations with embolization and Gamma Knife radiosurgery: comparative evaluation of the long-term results
掲載誌名	正式名：Surgical neurology 略　 称：Surg Neurol ISSNコード：00903019
巻・号・頁	71(1),pp.43-53
著者・共著者	IZAWA Masahiro†*, CHERNOV Mikhail, HAYASHI Motohiro, ISEKI Hiroshi, HORI Totokatsu, TAKAKURA Kintomo
発行年月	2009/01
概要	BACKGROUND: Volume reduction of large AVMs attained with endovascular embolization can be potentially helpful for their subsequent radiosurgical management. The objective of the present retrospective analysis was comparative evaluation of the long-term outcome after GKR for intracranial AVM performed with and without initial embolization of the nidus. METHODS: The long-term outcome in 15 patients with intracranial AVM treated with initial embolization and subsequent GKR was evaluated and compared with the series of 237 patients treated during the same period solely with GKR. All patients were followed at least 2 years after radiosurgery. RESULTS: Mean reductions of the nidus volume and score of the radiosurgery-based grading system for AVMs after embolization constituted 6.9 +/- 2.4 mL and 0.7 +/- 0.2, respectively (P < .001). Complete obliteration of the nidus after GKR was marked in 10 cases (67%). It was attained in 9 (90%) of 10 AVMs with postembolization nidus volume less than 12 mL, and in 1 (20%) of 5 with postembolization nidus volume more than 12 mL (P < .05). Delayed cyst formation was met once (7%). Obliteration and long-term morbidity rates did not differ significantly in patients treated with and without preradiosurgical nidus embolization, whereas nidus volume was seemingly larger in the former cohort. CONCLUSIONS: Combined management with embolization and GKR may be effective for selected cases of large intracranial AVM. Radiosurgery preceded by partial nidus embolization does not associate with increased rate of long-term complications.
DOI	10.1016/j.surneu.2007.11.016
文献番号	PMID: 18291487