선형가속기를 이용한 뇌동정맥기형의 뇌정위적 방사선 수술 치료결과
Result of Stereotactic LINAC Radiosurgery of AVM
소속 상세정보
손병철/Byung Chul Son
김문찬/강준기/서태석/윤세철/Moon Chan Kim/Joon Ki Kang/Tae Suk Suh/Sei Chul Yoon
KMID : 0359819990280010061
Abstract
결론
1988년 7월 8일 본 교실에서 처음으로 동정맥기형에 대한 선형가속기를 이용한 뇌정위적
방사선수술을 시행한 후 96년9월 CUMC normal mode의 completer dose planning이 시행되
기 전까지의 70례의 뇌혈관기형에 대한 제 1세대 선형가속기를 이용한 정위적 방사전 수술
의 결과를 분석하여 다음과 같은 결과를 얻었다.
1) 발현 증상, 징후로는 출혈이 가장 많은 31례(44.3%)를 차지하였으며 위치상으로는 두
정엽이 18례(25.7%)로 가장 많은 빈도를 차지하였다.
2) 최소한 2년이상 추적관찰이 가능하였던 49례를 동정맥 기형의 용적에 따라 5군으로 나
누어 다음과 같은 완전 폐색율을 얻었다. ① 1㎖이하(n=14) ; 85.7%, ② 1∼4㎖(n=21) ;
71.4%, ③ 4∼10㎖(n=4) ; 50%, ④ 10∼14㎖(n=4) ; 50%, ⑤ 14㎖이상(n=6), 50%이었으며,
이 49례 전체의 완전폐색율은 69.4%였다.
3) 증상을 보이는 방사선 합병증은 경험할 수 없었으나 자기공명영상 T2강조영상에서 신
호강도가 증가된 경우가 6례 발견할 수 있었다. 또한 정위적 방사선 수술후 70례중 4례
(5.7%)에서 출혈이 있었으며 이중 2명(2.8%)이 출혈로 인한 사망을 보였다.
There are several treatment modalities of cerebral arteriovenous malformation, among
these, sterotactic radiosurgery is effective means of obliteration of AVM with minimal
morbidity. Since July 1988 to May 1998, our institute have conducted 98 radiosurgery for
arteriovenous malformations. During this period, there were 2 major changes in
delivering radiation, the first one is introduction of computer dose planning system at
september 1996(CUMC normal mode), the next was CUMC Stereotactic mode using
non-flat filter delivery system since september 1997. Authors report the results of the
first generation LINAC(linear Accelerator) radiosurgery before introduction of computer
dose planning system for radiosurgery. During the first generation period(July 1988 to
september 1996), 70 patients have had stereotactic radiosurgery for vascular
malformation. Among these, 49 patients could be followed at least for 2 year with
angiography or MRA(magnetic resonance angiography). Hemorrhage was the most
common presenting causes of undergoing radiosurgery, the parietal love was the most
prevalent area undergoing radiosurgery for vascular malformations. With grouping of
volumes, vascular malformations were grouped as 1) volumes less than 1㎖(n=14), 2)
1-4㎖(n=21), 3) 4-10㎖(n=4), 4) 10-14㎖(n=4), 5) volumes over 14㎖(n=6), the results are
as follows : for group 1), total occlusion rate were 85.7％, for group 2), total occlusion
rate were 71.4％ for group 3), 4), 5), total occlusion rate were 50％. As a gross result of
49 patients, total occlusion rate was 69.4％, partial occlusion was 22.4％, no response
14.3％. 4cases of 70 radiosurgery for vascular malformation rebleeded(5.7％) and 2 of
these patients died of bleeding(2.9％). There was no symptomatic radiation complication,
but 6 patients showed increased signal intensity on T2 weighted image on follow up
magnetic resonance imaging.
Cerebreal arteriovenous malformation; Vascular malformation; LINAC radiosurgery; Occlusion rate; Radiation dose; Symptomatic radiation complication;
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