放射外科与立体定向放射治疗.ppt

* * * * * * * ? 疗效随访评价：  SRS治疗的放射生物学效应是逐渐发生的，不同随访时期相对各异，客观的疗效评价应从以下两方面进行： ①影像学显示的病变本身的作用和变化。 即：肿瘤局部控制率，血管畸形闭塞率和  可能伴随的脑水肿、脱髓鞘改变情况。 ②病员生存质量和稳定好转率。 肿瘤控制 消失 坏死缩小 无生长 生长控制（5年体积↑25%）畸形闭塞（金标准：DSA） 部分 完全 肿瘤局部控制率 良性 88～94% 恶性 46～82% 转移瘤 89～96% 血管畸形闭塞率 2年闭塞率 ＞80% 3年闭塞率 ＞90% 监测并发症情况 永久性并发症＜3～5% 质子刀、赛博刀、诺力刀与分次并发症低 CT (Contrasted) MRI (TW1) Mesencephalon AVMs DSA定位片与复查MRA 23ms after X-Knife 29ms after X-Knife Surgical complicationsPersistent neurological deficits associated with hemorrhage and stroke.Surgical outcome risk correlates with score on the Spetzler-Martin scale large-sized AVMs  deep venous drainage AVM in eloquent brain regionsA recent meta-analysis reports a morbidity of 8.6% and mortality of 3.3% after mostly surgical treatment in a series of 2452 patients.[19]?Spetzler-Martin grade of less or equal to 3 2-6.3% 0-2% Spetzler-Martin grade IV and V 9-39% and 0-9% Complications of endovascular embolizationPersistent neurological deficits related to inadvertent embolization of arteries supplying normal brain tissue or obliteration of the venous outflow leading to intracerebral hemorrhages. The procedure carries an associated risk for morbidity and mortality in the range of 9-22% and 0-9%, respectively.No long-term outcome studies are yet available; however, as endovascular techniques continue to improve, complication rates are likely to diminish. Complications of radiosurgeryDepend on the size and location of the AVM.  Eloquent areas and in central locations.White matter edema and radiation-induced necrosis may occur 1- to 3-year treatment period. Persistent neurological deficits after radiation have been reported in 8% of treated patients. Mean annual risk for hemorrhage of patients with hemorrhagic presentation was higher compared to patients with no