伽玛刀结合穿刺及内放疗治疗血管网状细胞瘤(附24例报道)

目的探讨伽玛刀结合穿刺及内放疗治疗血管网状细胞瘤的可行性.方法自1999年6月至2004年12月采用伽玛刀结合穿刺及内放疗治疗血管网状细胞瘤患者24例.结果14例患者病灶明显缩小（＞80%）,症状基本消失,可正常生活;6例患者病灶有所缩小（＜50%）,症状较前改善;2例病人为术后残留,均经两次伽玛刀治疗,但肿瘤仍进行性增大,行第二次开颅手术;2例病人伽玛刀治疗后3～4年病情加重死亡.结论采用伽玛刀结合穿刺及内放疗综合治疗血管网状细胞瘤患者,大部分能取得满意疗效,为术后残留及不宜或拒绝手术的患者提供了一条治疗新途径.     

伽玛刀治疗脑膜血管外膜细胞瘤的临床分析

目的 探讨伽玛刀治疗在脑膜血管外膜细胞瘤的综合治疗中的临床作用.方法 回顾性分析1994年12月至2006年12月于本中心行伽玛刀治疗并随访的22例术后复发的患者,男13例,女9例;58个瘤灶,平均体积5.4 cm3,平均周边剂量13.5 Gy,平均中心剂量28.2 Gy.结果 平均随访期26个月.22例中,颅内转移7例,颅外转移3例,死亡4例,平均生存期67.7个月;58个瘤灶中,影像随访证实25个基本消失,13个明显萎缩,14个体积变化不明显,6个体积增大,肿瘤总控制率89.7%.结论 伽玛刀治疗对术后残留或复发的中小型脑膜血管外膜细胞瘤安全有效,改变了以往综合治疗的策略.     

伽玛刀治疗海绵窦区海绵状血管瘤术后残留的疗效观察

目的 观察伽玛刀治疗海绵窦区海绵状血管瘤（CHCS）术后残留的疗效。方法回顾性分析6例经开颅手术后病理学确诊的CHCS术后残留患者的临床资料;均行伽马刀治疗,2例肿瘤最大径超过3.5 cm者行伽玛刀体积分割治疗;肿瘤周边剂量10~13 Gy,平均11.50 Gy;肿瘤中心剂量22~26 Gy,平均23.28 Gy。随访23~101个月,平均44.0月。结果 肿瘤基本消失2例,明显缩小2例,无变化1例,有效率为100%。患者均未出现新的颅神经受损症状。结论 伽玛刀对CHCS术后残留比较敏感,较低剂量即可控制其生长,疗效良好,且对体积较大的CHCS术后残留也可采用伽玛刀体积或剂量分割的方法就能获得良好的疗效。     

伽玛刀治疗颅内软骨肉瘤四例报道及文献回顾

目的 探讨伽玛刀放射外科治疗颅内软骨肉瘤的临床疗效. 方法 回顾性分析天津医科大学第二医院神经外科伽玛刀中心自2004年11月至2012年1月收治的4例软骨肉瘤患者诊治过程.4例患者均行手术切除并经病理证实,其中男1例,女3例;年龄26～36岁,平均31.3岁.肿瘤体积0.6～25.4 cm3,平均13.8 cm3;边缘剂量15～20 Gy,平均17.3 Gy;中心剂量30～40 Gy,平均35 Gy;靶点数4～19个,平均10个.本组随访时间5～28个月,平均14.5个月. 结果 1例左侧乳突及颈静脉孔区患者及1例鞍区患者治疗后分别随访19个月、9个月,肿瘤未见增大,生存良好;1例右侧眶颅沟通患者随访28个月后复发,后两次行手术治疗,效果不佳,于伽玛刀治疗后56个月死亡;1例左侧鞍旁患者治疗后5个月肿瘤复发,伴脑积水,随后失访.4例均未出现任何与伽玛刀治疗相关的并发症. 结论 伽玛刀治疗定位精确度高,疗效可靠且对周围组织损伤小,可作为术后残留软骨肉瘤辅助治疗方法.     

海绵窦海绵状血管瘤的伽玛刀治疗（附11例分析）

目的评估伽玛刀治疗海绵窦海绵状血管瘤的效果。方法应用伽玛刀治疗海绵窦海绵状血管瘤11例,其中术后残留（病理证实）5例,影像学诊断6例;肿瘤直径2.5～4.0cm。周边剂量9～16Gy,平均13Gy;中心剂量20.0～35.5Gy,平均28.3Gy;等剂量曲线40%～50%,平均46%。结果10例病人获随访,随访时间19～96个月,平均53.7个月。病人均未出现新的脑神经受损表现。1年后,病人症状均有明显改善或消失。MRI显示病灶几乎消失2例,缩小5例,无明显变化3例。结论伽玛刀治疗海绵窦海绵状血管瘤安全可靠,效果良好,适用于肿瘤较小、大型肿瘤术后残留及复发病人。     

脑膜血管外皮细胞瘤的伽玛刀治疗

目的探讨脑膜血管外皮细胞瘤与非恶性脑膜瘤的鉴别诊断,评估伽玛刀治疗复发性脑膜血管外皮细胞瘤的疗效。方法本文回顾分析了本中心自2000年至2002年伽玛刀治疗的5例术后复发的脑膜血管外皮细胞瘤,共7个瘤灶,平均体积3.2cm3,平均周边剂量12Gy,平均中心剂量27.5Gy。结果平均随访时间19.8个月,从影像看,1个瘤灶消失,4个明显缩小,2个继续增大,肿瘤控制率71%。结论伽玛刀治疗脑膜血管外皮细胞瘤能起到良好的局部控制作用,是综合治疗的一个重要部分,治疗后每隔半年随访一次是必要的。     

海绵窦海绵状血管瘤的临床特点及伽玛刀治疗效果

目的 回顾性分析评价伽玛刀对海绵窦海绵状血管瘤的治疗作用. 方法 海军总医院全军神经外科研究所自1997年11月至2011年6月应用伽玛刀治疗海绵窦海绵状血管瘤33例,其中10例为术后残留,23例经影像诊断.肿瘤平均直径29 mm(12～65 mm).伽玛刀治疗的平均周边剂量12.5Gy(9～16Gy),平均等剂量曲线47.7％(40％～50％). 结果 32例患者获随访,平均随访时间46个月(6～135个月).30例(93.8％)治疗后症状明显好转或消失,2例(6.2％)同治疗前.本组治疗后无其他颅神经功能受损症状出现;肿瘤基本消失9例(28.1％),肿瘤体积明显萎缩21例(65.6％),体积较伽玛刀治疗前无明显改变2例(6.7％),肿瘤总控制率100％.2例患者因治疗前肿瘤体积巨大行分次伽玛刀治疗. 结论 伽玛刀治疗海绵窦海绵状血管瘤安全有效,并可有效改善其临床症状.     

术后残留中枢神经细胞瘤的放射治疗(附六例报告)

目的 探讨放射治疗在术后残留或复发中枢神经细胞瘤中的作用.方法 分析2003年6月至2005年6月收治的6例手术后残留或复发的中枢神经细胞瘤的放射治疗结果 ,并综述文献报道.结果 5例病人接受外放射治疗,放射剂量55～60 Gy,随访24-36个月(平均30个月),病变消失1例,缩小4例.其中1例于放射治疗结束后6个月时出现一侧丘脑放射性坏死.1例病人行伽玛刀治疗,周边剂量15 Gy,随访至18个月时病变已明显缩小.结论 中枢性神经细胞瘤确对放射治疗敏感,对术后残留或复发者可以考虑分次外放射治疗,54 Gy可能是治疗中枢神经细胞瘤的最低有效剂量,但应注意放射性副损伤或放射性坏死发生的可能,对小体积肿瘤,立体定向放射外科治疗则是一种安全有效的辅助治疗.     

海绵窦海绵状血管瘤伽玛刀分次治疗的效果分析

目的探讨伽玛刀分次治疗海绵窦海绵状血管瘤(CH)的效果。方法回顾性分析11例海绵窦CH的临床资料。肿瘤MRI特点:T_1WI呈低或略等信号,T_2WI呈均匀高信号,增强扫描肿瘤均匀强化,肿瘤直径40～78 mm。行Leksell伽玛刀6～8个月内分次治疗方案,首次伽玛刀治疗肿瘤中心剂量25 Gy,平均边缘剂量9 Gy;第二次治疗中心剂量30 Gy,边缘15 Gy。结果随访6～48个月,平均36个月。病人均未出现新的脑神经受损症状,原有症状均不同程度改善。影像学结果:伽玛刀术后6～12个月肿瘤基本消失2例,明显缩小9例。结论伽玛刀分次治疗海绵窦CH疗效良好疗效。     

累及眶内肿瘤的伽玛刀治疗

目的 总结累及眶内肿瘤的伽玛刀治疗效果.方法 共治疗累及眶内的肿瘤患者35例,随访25例(脑膜瘤16例,脑膜血管外皮细胞瘤3例,神经鞘瘤2例,腺样囊性癌2例,转移癌1例,血管纤维瘤1例),采取1.5T PHILIPS或3.0T GE磁共振2 mm薄层扫描定位,Kula或GammaPlan剂量计划系统.肿瘤平均体积2.91 cm3(0.17～19.50 cm3),平均周边剂量12.4 Gy(8～15 Gy),中心剂量26.7 Gy(16～32 Gy).结果 本组随访期为1-62个月,平均30.4个月,23例控制满意,总体控制率为92%;6例(24%)症状减轻,13例(52%)症状无改变,5例(20%)出现了一过性的新发或原有症状加重;2例肿瘤增大,其中1例因突眼加重而行手术治疗.结论 对于累及眶内的较小病变、或经手术治疗后残留、复发等不宜手术治疗的病例,伽玛刀治疗可作为综合治疗的重要手段.     

Gamma knife radiosurgery for residual skull base chordomas

OBJECTIVE: The location of chordomas within the base of the skull and cervical junction prevents complete resection from being achieved. Previous series have shown that stereotactic radiosurgery can be used as a treatment for residual chordomas with good overall results. In the present study, we reviewed our experience in using gamma knife surgery (GKS) to treat patients with residual skull base chordomas. METHODS: Thirty-one patients with residual skull base chordomas underwent gamma knife radiosurgery from June 1996 to December 2004. The mean age of patients was 40.2 years (range: 8-70 years). There were 20 male and 11 females. The post-operative tumor volume treated with GKS ranged from 0.47 to 27.6 cm3, with a mean of 11.4+/-7.4 cm3. The mean tumor margin radiation dose was 12.7 Gy (range: 10-16 Gy), and the mean maximum dose was 29.2 Gy (range: 20.8-40 Gy). Twenty-eight patients were available for follow-up reviews, ranging from 6 to 102 months (mean: 30.2 months) and from 6 to 78 months (mean: 28 months), for clinical and image assessments, respectively. RESULTS: Kaplan-Meier survival analysis showed a survival of 90.9 and 75.8% after 3 and 5 years, respectively. Most tumors were smaller in size 1 year after treatment, which paralleled an alleviation of clinical symptoms. However, nine chordomas progressed, and seven recurred over the course of follow-up. The actuarial tumor control rate was 64.2 and 21.4% after 3 and 5 years, respectively. No serious radiation-related complication was found in any of the patients with GKS alone. CONCLUSIONS: Gamma knife radiosurgery can be effectively used for residual chordomas beside surgical resection with efficacious tumor control rates.     

Stereotactic gamma knife radiosurgery. Initial North American experience in 207 patients

The first North American gamma knife for stereotactic radiosurgery of brain tumors and arteriovenous malformations entered the therapeutic armamentarium at the University of Pittsburgh (Pa) on August 14, 1987. In this article, we report our initial testing and subsequent experience with this technique. In the first 16 months of operation, 207 patients were treated (113 had arteriovenous malformations, 78 had extra-axial skull base neoplasms, 9 had glial neoplasms, and 7 had metastatic tumors). The patients' lesions either were considered previously as "inoperable" or were residual lesions after attempted surgical resection, or the radiosurgery was performed after the patient declined surgical excision. Gamma radiosurgery was associated with no surgical mortality and no significant early morbidity, and the results were encouraging during the minimum follow-up period of 6 months. Compared with treatment by conventional intracranial surgery (craniotomy), both the average length of stay and hospital charges for radiosurgery were significantly lower. Our initial experience further suggests that stereotactic radiosurgery using the gamma knife is a therapeutically effective and economically sound alternative to microneurosurgical removal of selected intracranial tumors and vascular malformations.     

侵袭性蝶骨嵴内侧型脑膜瘤手术配合术后伽玛刀治疗初探

目的探讨蝶骨嵴内侧型脑膜瘤的手术切除 立体定向放射手术伽码刀(γ-刀)治疗作用.方法本文回顾性分析了26例侵袭性蝶骨嵴内侧型脑膜瘤采用手术 伽玛刀治疗的临床资料.结果本组26例全部随诊12～48个月,手术切除术后残瘤均经伽玛刀治疗,肿瘤控制率92.3%,无效率7.7%,病死率0,无偏瘫及颅神经损伤.结论手术 伽玛刀是治疗侵袭性蝶骨嵴内侧型脑膜瘤安全和有效的治疗方法.     

Adjuvant gamma knife radiosurgery after meningioma resection.

We evaluated the usefulness of adjuvant treatment with gamma knife radiosurgery following meningioma surgery. During the past 8 years, we operated on 78 patients with meningiomas. Among these, 28 patients (36%) received gamma knife radiosurgery postoperatively. The indications for radiosurgery were as follows: residual tumour after surgery in 13 patients (46.4%), regrowth of residual tumour during the follow-up period in 7 patients (25%), recurrence after total removal (Simpson grade 1 or 2) in 7 patients (25%), and another intracranial meningioma in one patient (3.6%). The tumour diameter at the time of radiosurgery ranged from 5.2 to 48.1 mm (median 21.6 mm). Larger tumours with a mean diameter above 40 mm in two patients were treated with two-staged radiosurgery. The tumor marginal dose ranged from 8 to 23 Gy (median 12 Gy). The follow-up period was 3-84 months (median 30 months) after radiosurgery. The tumour size decreased in 17 patients (60.7%), remained unchanged in 9 patients (32.1%), and increased in 2 patients (7.2%). No radiation injury was experienced. Adjuvant therapy using gamma knife radiosurgery for meningiomas can achieve control of tumour growth and may improve patient outcomes. Careful surgical planning and follow-up are required to understand the usefulness and limitations of radiosurgery in this setting.     

巨大脑胶质瘤伽玛刀分次治疗的理论与实践

目的 探讨巨大脑胶质瘤伽玛刀分次治疗的理论依据及实际疗效。方法 供鉴分割治疗及放射外科动物实验的理论结果,设计出巨大脑胶质瘤的伽玛刀分次治疗,治疗分2次或3次完成,每次间隔1d,分次照射的周边剂量为5－10Gy。治疗效果通过MRI和临床表现综合评估。结果 随访3－33个月,28例巨大脑胶质瘤分次伽玛刀治疗有效率为78．6％,2例病人伽玛刀术后出现迟发性脑水肿。治疗效果与肿瘤分化程度有关,与肿瘤大小无关。结论 巨大脑胶质瘤分次伽玛刀治疗的理论依据充分,实际治疗效果显,其远期疗效尚需继续随诊。     

颅咽管瘤的伽玛刀放射外科治疗

目的评估伽玛刀放射外科治疗颅咽管瘤的长期疗效及安全性。方法回顾性分析25例使用Leksell伽玛刀治疗颅咽管瘤的临床资料,其中实体性肿瘤5例,囊性肿瘤9例,囊实混合性肿瘤11例;肿瘤体积0.22~16.2 cm3。行剂量分割治疗5例,边缘剂量6~8 Gy,50%等剂量曲线;行单次治疗20例,边缘剂量10~15 Gy,35%~50%等剂量曲线。视神经、视束受照剂量控制在10 Gy以下。结果所有病人随访5~139个月,临床症状获得不同程度改善。MRI检查显示:肿瘤消失5例,缩小13例,无变化3例,治疗后囊液反复出现4例,经Ommaya囊抽液治疗后好转。结论伽玛刀治疗颅咽管瘤是一种安全、有效的方法,对小的实性肿瘤,可置管抽液的囊性肿瘤及术后残余肿瘤可作为首选治疗方法。     

Role of radiosurgery in the management of cavernous sinus meningiomas

Objective - To provide our early experience and philosophy in the utility of radiosurgery in the management of cavernous sinus meningiomas. Methods - Twenty-five consecutive cases with cavernous sinus meningiomas treated between 1990 and 1995 were reviewed. Three cases were treated with gamma-knife radiosurgery, 15 with preceding surgery and gamma knife, 7 with surgery. Mean follow-up following radiosurgery and surgery were 34.8 and 25.4 months, respectively. Results - The 5-year actuarial tumor control rate following radiosurgery was 85.7% and tumor remission rate was 61.4%. Permanent neurological deterioration after radiosurgery was seen in 1 case (5.9%), whereas newly developed or worsened neurological deficits permanently persisted in 59.1% of patients after surgery. There was a clear correlation between surgical radicality and postoperative morbidity rate. Conclusions - Gamma-knife radiosurgery is a valuable addition to surgical removal in the treatment of cavernous sinus meningiomas. Combination of non-radical resection and subsequent radiosurgery is recommended to improve treatment-associated morbidity.     

肢端肥大症患者79例临床治疗分析

目的探讨使用长效生长抑素类似物结合神经外科切除或伽玛刀治疗后激素变化和影像学复查来评价肢端肥大症患者治疗疗效。方法肢端肥大症患者79例,其中男性51例,女性28例,分为长效生长抑素（兰瑞肽lanreotide^TM）结合神经外科切除治疗（A组）和长效生长抑素（兰瑞肽lanreotide^TM）结合伽玛刀治疗组（B组）,所有患者均给予肌注长效生长抑素,在药物使用结束4w后对患者进行临床评估并施行经蝶窦手术切除肿瘤或者接受伽玛刀治疗。随访瘤体体积变化及内分泌水平变化。结果多数患者的临床症状得到显著改善。与垂体微腺瘤组相比,药物治疗对垂体大腺瘤组体积缩小有更明显的作用。手术组微腺瘤组明显优于大腺瘤组;放射外科组结果：肿瘤缩小概率随随访时间的延长会明显提高,而且随着随访时间的延长,生长激素（GH）和胰岛素生长因子（IGF-Ⅰ）值降至正常的概率明显提高。结论生长抑素类似物（兰瑞肽lanreotide^TM）结合神经外科切除或伽玛刀治疗肢端肥大症患者可以获得较好的临床疗效,远期疗效有待于进一步观察。     

Childhood meningioma: unusual location, atypical radiological findings, and favorable treatment outcome

OBJECTS: To investigate the characteristics of childhood meningioma, especially, locations, radiological findings, pathological features (including proliferative potential) and outcome, 11 children with meningiomas were retrospectively analyzed. RESULTS: Unusual location, large size, frequent calcification, and cyst formation were characteristic radiological findings. Gross total resection was achieved in 8 patients, and there was recurrence in 2. Gamma knife radiosurgery was performed on residual and recurrent tumors. MIB-1 indices tended to be high in large tumors. Nine patients had a Karnofsky Performance Scale of more than 70 during the follow-up period of 10 months to 19.5 years. Surgical treatment rendered 4 of 5 epileptic patients seizure free. The childhood meningiomas examined had unusual locations, atypical radiological findings, and various proliferative potentials. CONCLUSIONS: Complete resection is the treatment of choice. Gamma knife radiosurgery can be a good alternative for residual tumors and small recurrent tumors. The outcome of childhood meningiomas is good after surgery.     

巨大脑胶质瘤的分次伽玛刀治疗

目的 探讨巨大脑胶质瘤的分次γ刀治疗及其疗效。方法 巨大脑胶质瘤的γ刀治疗分两次或三次完成,每次间隔1d,分次照射的周边剂量为5～10 Gy。治疗效果通过MRI和临床表现综合评估。结果 随访3～33月,28例巨大脑胶质瘤分次γ刀治疗有效率为78.6％,2例病人γ刀术后出现迟发性脑水肿。治疗效果与肿瘤分化程度有关,而与肿瘤大小无关。结论 巨大脑胶质瘤分次γ刀治疗效果显著,但其远期疗效有待进一步的临床和实验观察。