CT结合脑立体定向仪定位切除颅内病灶

目的：研究ＣＴ结合脑立体仪定位切除颅内病灶的效果。方法：对２２例病变直径〈１．５￣３．５ｃｍ患者采用ＣＴ结合脑立体定向仪定位,显微镜下切除病灶。结果：２２例患者中,２肺癌脑转移行肉眼全切,３例胶质瘤行大部切除,余１７便行全部切除,术后均无并发症。１６例继发性癫痫中,１３例术后停止发作。结论：ＣＴ结合脑立体定向仪定位切除颅内小病灶的 定位准确,损伤小,值得提倡。     

立体定向放射性脑水肿危险性因素分析

目的 分析立体定向放射外科（ＳＲＳ）诱导放射性脑水肿的危险因素。方法 回顾性分析接受Ｘ刀治疗且有完整影像学随访资料的病人６７例,分成两组：水肿组（２２例）、对照组（４７例）,采用单因素分析（χ＾２或Ｗｉｌｃｏｘｏｎ秩和检验）和ｌｏｇｉｓｔｉｃ回归分析方法分析年龄、性别、肿瘤体积、最大剂量、边缘剂量、肿瘤位置、靶点数目、１０Ｇｙ剂量覆盖的体积及随访时间对治疗后脑水肿的影响。结果 单因素分析提示肿瘤体     

颅内疾病X-刀立体定向放射神经外科治疗510例

目的 分析Ｘ－刀立体定向放射神经外科治疗颅内疾病的疗效,方法 用ＣＴ薄层连扫描图像定位,采用ＢＲＷ立体定向坐标系统,ＲａｄｉｏｎｉｃｓＲＳＡ－３型Ｘ－刀治疗计划系统,ＰｈｉｌｉｐｓＳＬ－７５－１４医用电子直线加速器,对５１０例颅内疾病患实施Ｘ－刀治疗。结果 平均随访时间为１５（３￣３６）ｍｏ,其中多数病例在治疗后１￣６ｍｏ出现明显的症状改善和影像学检查显示病灶缩小或消失等改变。结论合理选择适应症     

Prognostic value of the Spetzler's grading system in a series of cerebral AVMs treated by a combined management

Summary The prognostic value of the Spetzler's grading system is studied in a series of 52 AVMs treated by a combined management, using one or several of the 3 available techniques: surgical resection, endovascular embolization, radiosurgery.The symptoms at the time of treatment were haemorrhage 50%, seizures 31%, headache and deficit 19%. Three grade groups were considered: I and II (31%), III (33%), IV and V (36%). Overall, AVMs were managed as follows: resection alone 25%, embolization plus resection 23%, embolization alone 23%, radiosurgery with various combinations 29%. According to the grade groups, the most frequently used technique was resection alone for grade I–II AVMs (44%), radiosurgery for grade III AVMs (41%) and embolization alone for grade IV–V AVMs (42%).The clinical outcome was evaluated in terms of deterioration due to treatment. The best results were obtained in grade I–II AVMs (81% with no deterioration) then in grade III AVMs (65%) and in grade IV–V (58%). However, when we consider the outcome in terms of favourable results (no or only minor deterioration) we obtained a similar outcome for grade I–II and grade III AVMs (94% each), and only 79% for grade IV–V malformations. The angiographic outcome showed a better eradication rate in grade III AVMs (88% complete eradication), than in grade I–II AVMs (75%) and in grade IV–V (47%).Our conclusion is that the Spetzler's grading system in this series was well correlated with both the clinical and the angiographic outcome. However, we found no real difference between grade I–II and grade III AVMs. So, in terms of prognostic value, the grade I, II, and III AVMs could be considered together as low-grade malformations, with a better prognosis than the high-grade malformations (grade IV and V).     

Volumetric reconstruction and stereotactic computer assisted resection in intracerebral lesions

Summary Since 1990 112 patients have undergone Stereotactic resection of intra-axial tumoural lesions with volumetric reconstruction, using the Kelly-Goerss system. Stereotactic integration of CT, angiographic and particularly MRI information, together with three-dimensional information of the lesion, provide an innovative evaluation of the most appropriate surgical approach, even for each single patient. The main limitation of this surgical method is in cases where the infiltrating part of the tumour is pre-eminent, while it can allow macroscopically complete resection of well circumscribed lesions, almost independently of their location and volume. Some technical aspects of Stereotactic resection of brain tumours are discussed in the light of our experience.     

小分割分次立体定向放射治疗脑转移瘤近期疗效观察

目的观察小分割分次立体定向放射治疗(fractionated stereotatic radiation therapy,FSRT)脑转移瘤的近期疗效.方法15例病人单纯全脑外照射(WBRT组),中间平面剂量20～40Gy/10～20次/2～4周.17例病人接受FSRT(FSRT组),每次分次剂量为2.5～3.0Gy.其中11病人行单纯FSRT,中心总剂量为30～60Gy/1 0～20次/2～4周;6例病人先行WBRT,然后行FSRT,中心总剂量为46～60Gy/5～6周.结果KSP评分增加10分以上者,WBRT组为5 3.3%,FSRT组为82.4%.(P＜0.05).WBRT组有效率(CR PR)为50.0%;FSRT组有效率(CR PR)为80.0%.中位生存率:WBRT组为3.5月,FSRT组为10.0月.结论FSRT能有效地控制脑转移瘤,减轻神经系统症状,提高生存质量,延长病人生存期,而没有增加副作用,值得临床推广应用.     

立体定向适形放疗治疗晚期胆管癌的疗效评价

目的 探讨立体定向适形放疗治疗晚期胆管癌的疗效。方法对 18例晚期胆管癌患者，采用立体定向适形放疗技术，总剂量平均为42．6Gy(32-48Gy)，分7-9次完成(隔天1次)，每次照射剂量为4-6Gy。结果治疗结束后，黄疸明显消退；CR 11例(61．1％)，PR5例(27．8％)，有效率为88．9％；随访中位生存期为15．4个月，1年生存率为61．5％(8/13)。结论 立体定向适形放射治疗晚期胆管癌，能改善患者的生存质量及预后。     

大垂体肿瘤的立体定向放射治疗

目的 探讨大垂体肿瘤立体定向放射治疗(stereotatic radiotherapy,SRT)的效果和视力保护问题。方法 11例大垂体肿瘤患者,肿瘤中位直径为4 cm,2例垂体肿瘤距视神经或视交叉的距离≥2 mm,其余患者肿瘤则紧贴视神经或视交叉。本组患者用X线分次立体定向放射治疗,每次剂量为5～7 Gy,每周2～3次,总剂量为40 Gy。做计划时使80％等剂量线避开视神经或视交叉。结果 肿瘤经分次SRT后体积明显缩小90.9％(10/11),视力有改善者占90.9％(10/11)。结论 SRT治疗大垂体肿瘤是有效的,对于肿瘤距视神经或视交叉的距离≤2 mm的垂体肿瘤,只要掌握好合适的分割剂量和次数,不会出现视力障碍。     

CT引导脑立体定向手术临床研究(附127例报告)

目的 研究CT引导脑立体定向手术的临床应用价值。方法 采用CT引导行立体定向手术127例，其中包括帕金森病、脑肿瘤内放疗、精神分裂症、扭转痉挛、脑脓肿、高血压脑出血、脑肿瘤活检、脑内异物取出、透明隔囊肿、脑肿瘤开放立体定向等手术。结果 手术有效率96．1％(术后1个月)，无手术死亡及术后昏迷、偏瘫、颅内出血和感染等严重并发症。结论 CT引导脑立体定向手术具有定位准确、创伤小、操作简便、手术风险小、并发症少、患者易于接受等优点，扩大了手术范围，提高了手术安全性。     

Interpreting the improved outcome of patients with central nervous system metastases managed in clinical trials compared with standard hospital practice*

The aims were to determine the median survival and prognostic factors of patients with central nervous system (CNS) metastases managed with whole‐brain radiation therapy (WBRT), and to explore selection criteria in recently published clinical trials using aggressive interventions in CNS metastases. A retrospective audit was performed on patients managed with WBRT for CNS metastases. Potential prognostic factors were recorded and analysed for their association with survival duration. The proportion of patients with these factors was also compared with those of patients managed under three recently reported studies investigating aggressive interventions, such as radiosurgery and chemotherapy for CNS metastases. Seventy‐three patients were treated with WBRT for cerebral metastases over a 12‐month period. The median survival of the population was 3.4 months (95% confidence interval: 2.7–4.1), with 6‐ and 12‐month survival rates of 30 and 18%, respectively. Significant prognostic factors for prolonged median survival were Eastern Cooperative Oncology Group status 0–2 (P = 0.015), Medical Research Council neurological functional status 0–1 (P = 0.006), and Recursive Partitioning Analysis Class 2 versus Class 3 (P = 0.020). On multivariate analysis, younger patient age (P = 0.02) and better performance status (P < 0.01) were associated with improved outcome. When comparing these characteristics with selected published studies, our study cohort demonstrated a higher proportion of patients with poor performance status, a greater number of metastases per patient and a higher incidence of extracranial disease. This reflects the selected nature of patients in these published studies. Central nervous system metastases confer a poor prognosis and, for the majority of patients, aggressive interventions are unlikely to improve survival. The use of potentially toxic and expensive treatments should be reserved for those few in whom these studies have shown a potential benefit.