摘要
目的评价伽马刀对海绵窦海绵状血管瘤的安全性及疗效。方法回顾性连续纳入2010年6月至2016年7月四川大学华西医院神经外科经伽马刀治疗的海绵窦海绵状血管瘤患者35例,其中男13例,女22例。术前均经MRI确诊,术后经组织病理证实或经MRI进一步验证。伽马刀肿瘤周边照射剂量为11~16 Gy,平均(14.3±1.1)Gy,45%~50%等剂量线覆盖,确保视交叉受照射剂量低于8 Gy。术后第1年,分别于术后3、6、9、12个月进行随访,以后1次/年,患者来院进行临床疗效、手术相关并发症及肿瘤体积的评价。结果 35例患者随访12~77个月,平均(36±4)个月,全部病例未出现与手术相关的视神经损伤及新的颅神经损伤。有症状患者28例(80.0%),症状改善率为96.4%(27例),其中症状改善15例(53.6%),症状消失12例(42.9%),无变化1例(3.6%),未发生症状恶化。症状改善时间为术后2~7个月,平均(3.7±0.3)个月。影像学随访显示,35例经伽马刀治疗的海绵窦海绵状血管瘤患者,治疗后肿瘤体积较治疗前明显缩小,差异有统计学意义[(8.8±0.9)cm^3比(32.6±3.6)cm^3,t=8.492,P<0.01];肿瘤体积缩小率≤25%、26%~50%、51%~75%、≥75%分别有3(8.6%)、2(5.7%)、8(22.9%)和22(62.9%)例。结论伽马刀治疗海绵窦海绵状血管瘤安全性好,疗效明确,可作为该病首选的治疗方式,但需长期随访观察其远期疗效。
Object Ive To evaluate the safety and efficacy of Gamma knife radiosurgery for the treatment of cavernous sinus cavernous hemangioma. Methods From June 2010 to July 2016,35 consecutive patients with cavernous sinus cavernous hemangioma treated with Gamma knife radiosurgery at the Department of Neurosurgery,West China Hospital,Sichuan University were enrolled retrospective,including 22 females and 13 males. All patients were diagnosed by MRI before procedure. They were confirmed by postoperative histopathology or further verification by MRI. The irradiation dose of Gamma knife around tumors were 11-16 Gy（ mean 14. 3 ± 1. 1 Gy）,covered by 45 %-50 % isodose line and ensured that the exposure dose of the optic cross was less than 8 Gy. In the first year after operation,they were followed up at 3,6,9,and 12 months,and after that,the clinical efficacy,surgical complications and tumor volume were evaluated once a year. Results Thirty-five patients were followed up for 12-77 months（ mean36 ± 4 months）. No surgery-related optic nerve injury and new cranial nerve injury occurred in all cases. Symptomatic patients were 28（ 80%） and symptomatic improvement rate was 96. 4%（ n = 27）,among them,the symptoms were improved in 15 cases（ 53. 6%）,and the symptoms disappeared in 12 cases（ 42. 9%）,did not have any change in 1（ 3. 6%） case,and no symptom deterioration occurred. The symptom improvement time was 2-7 months after surgery（ mean 3. 7 ± 0. 3 months）. Imaging follow-up revealed that in 35 patients with cavernous sinus cavernous hemangioma treated by gamma knife radiosurgery,the tumor volume was significantly reduced after treatment compared with that before treatment,and the difference was statistically significant（ 8. 8 ± 0. 9 cm^3 vs. 32. 6 ± 3. 6 cm^3,t = 8. 492,P〈0. 01）. The rates of tumor volume change were ≤25 %,26 %-50 %,51 %-75 %,and ≥75 %. There were 3 patients（ 8. 6 %）,2（ 5. 7%）,8（ 22. 9%）,and 22（ 62. 9%）,respectively. Conclusions Gamma knife radiosurgery is safe and effective in the treatment of cavernous sinus cavernous hemangioma. It can be used as the preferred treatment modality for this disease,but long-term follow-up is needed to observe its long-term efficacy.
作者
任海波
王毅
李鹏
王伟
Ren Haibo;Wang Yi;Li Peng;Wang Wei(Department of Neurosurgery , West China Hospital, Sichuan University, Chengdu 610041, China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2018年第6期304-308,共5页
Chinese Journal of Cerebrovascular Diseases
关键词
血管瘤
海绵状
中枢神经系统
海绵窦
伽马刀
Hemangioma
cavernous
central nervous system
Cavernous sinus
Gamma knife radiosurgery
