伽玛刀治疗听神经瘤临近神经损伤的随访分析

目的观察伽玛刀治疗听神经瘤后临近神经损伤与修复.方法采用OUR旋转式伽玛刀治疗.10-20mm肿瘤周边剂量平均15Gy,中心剂量32Gy,21-30mm肿瘤周边剂量平均14Gy,中心剂量31Gy,31mm以上肿瘤周边剂量平均12Gy,中心剂量28Gy.治疗43例46个听神经瘤.结果随访6-24个月,肿瘤总控制率91.3%.治疗前听力正常患者,有用听力保留率6个月87%,2年78%.面、三叉神经放射损伤在治疗后半年出现,分别占15.3%和¨.4%,12个月时为7.6%和3.8%,24个月时均为3.8%.3厘米以内肿瘤均为3.8%,且一年恢复正常;3厘米以上肿瘤分别为¨.5%和7.6%,治疗后2年均为3.8%.听力下降的23例治疗后,2cm以内肿瘤听力仍保留在治疗前水平的为100%.结论伽玛刀治疗听神经瘤是安全、有效、简单的方法,特别适用于术后残存或复发、需保留听力及高危病人,小于30mm的肿瘤治疗效果好.伽玛刀治疗具有较高的有用听力保护率和相对低的面、三叉神经损伤率.     

听神经瘤的伽玛刀放射外科治疗

目的总结评价伽玛刀放射外科治疗听神经瘤的效果.方法43例患者年龄19～76(平均50.2)岁,男女=1924.单侧病变41例,双侧病变2例.9例术后残留或复发患者.56%的病例术前有有用听力.肿瘤平均容积10.8ml.伽玛刀治疗边缘剂量10～14Gy,平均11.7Gy,中心剂量21～30Gy,平均24.9Gy.随访期18～62(平均36.6)个月.结果43例患者中32例(74%)肿瘤缩小,9例(21%)大小无变化.2例容积增大,1例在随访18个月时接受了再次伽玛刀治疗.5例出现三叉神经功能障碍,3例出现面瘫,32例可评价的病例中,有23例有用听力得到保留.5例患者听力较术前明显改善.结论伽玛刀治疗听神经瘤控制肿瘤生长,取得较高的神经功能保留率,可达到外科手术同样的治疗效果.     

听神经瘤的放射外科治疗：5年临床总结

目的探讨伽玛刀治疗听神经瘤的临床效果.方法应用伽玛刀治疗听神经瘤145例,采用30%～60%等剂量曲线,总边剂量10～15Gy(平均13.8G);中心剂量16～45Gy(平均32.5Gy),治疗后3个月开始随访,随访时间12～60个月,平均随访30个月.结果肿瘤生长控制率93.7%;听力保存率83.8%,面神经及三叉神经迟发性受损率分别为9.6%和7.8%;无死亡及严重并发症发生.结论γ-刀治疗听神经瘤是一种安全、有效的手段.     

听神经瘤的小剂量放射手术效果

目的为观察减少肿瘤边缘放射剂量对听神经瘤的放射手术效果的改善情况,作者报道了听神经瘤小剂量放射手术后超过5年的随访结果。方法对1994年1月～1996年12月连续收治的51例单侧听神经瘤病人行小剂量γ-刀放射手术治疗,肿瘤边缘剂量小于12Gy。病人年龄32～76岁,平均55岁。治疗体积0.7～24.9cm3,平均3.6cm3;边缘放射剂量8～12Gy。随访18～96个月,平均60个月。结果临床肿瘤生长控制率达96%,5年肿瘤控制率为92%。放射手术前听力保留者(Gardner-RobertsonⅠ～Ⅳ)中59%的病人放射手术后听力保留,在听力减退的病人中9%放射手术后听力改善,56%听…     

伽玛刀治疗颅底良性脑膜瘤长期疗效分析

目的总结评价伽玛刀(γ刀)治疗颅底良性脑膜瘤的长期疗效。方法217例患者平均年龄52.2±13.8岁(9～83岁),男性65例,女性152例;病史0.5～216个月,平均35.5个月,中位时间26个月;105例曾行手术治疗;肿瘤容积0.41～42.8cm3,平均6.8±6.1cm3;均行增强MRI定位扫描;边缘剂量10～20Gy,平均13.9±1.8Gy,中心剂量22.2～40Gy,平均27.7±4.6Gy;等剂量曲线40%～60%,平均49.53%;等中心数2～20个,平均10个。结果随访36～120(平均69.8±21.8)个月,肿瘤控制率为97.7%(212/217);临床表现:130例(59.9%)好转,78例(35.9%)稳定,9例(4.1%)恶化;9例曾出现一过性症状加重;2例(0.9%)出现放射性水肿;6例(2.8%)于γ刀后行显微外科手术切除。结论伽玛刀治疗颅底脑膜瘤可长期控制肿瘤生长,并发症较少,能保证患者良好的生存质量,即为术后残留或复发的患者提供了进一步治疗的方法,也为较小颅底脑膜瘤患者治疗的主要疗法。     

听神经瘤的γ—刀治疗（附119例随访报告）

目的 评价伽玛刀（γ－刀）治疗听神经瘤的疗效。方法 用Leksell B型γ-刀治疗听神经瘤119例,并随访1－5年。扫描定位用1．5Tesla磁共振仪,剂量规划系统为γ-plan4.0版。肿瘤体积0．02－20．8cm^3;周边剂量9－17Gy,平均13Gy;中心剂量18－45Gy,平均32Gy;靶点数2－10个,平均4个。结果 肿瘤体积缩小95例（80％）,其中显效16例（13％,指体积缩小超过75％）,无变化14例（12％）,增大10例（8％）。61例（51％）听力有保存,11例（9％）听力有改善;5例半年后出现面瘫,1列持续5周后消失,2例经再次手术后好转,另有2例有永久面瘫;3例病人出现三叉神经痛,2例为一过性,1例服药好转。结论 γ-刀治疗对听神经瘤具有良好的控制生长作用,尤其适合体积＜6．5cm^3及不宜开颅手术的病人,对颅神经的损伤风险低,是一种安全有效的治疗方法。     

三叉神经鞘瘤的放射治疗临床研究

目的回顾性分析γ刀放射对三叉神经鞘瘤的治疗作用及治疗剂量。方法应用γ刀治疗三叉神经鞘瘤42例获得随访资料,29例经影像学检查结合临床诊断首选γ刀治疗,13例为术后复发或残留,肿瘤直径31±6.8mm,肿瘤的平均体积10.4±2.8cm3。结果42例患者平均随访时间62个月。临床症状改善情况:有11例例症状完全消失,25例患者症状改善;6例患者症状改善不明显或者症状加重;临床症状改善总有效率为85.7%。肿瘤体积控制情况:13例肿瘤基本消失,21例肿瘤明显缩小(最大径缩小1/3以上),5例肿瘤未增大(肿瘤最大径缩小少于1/3以上),3例肿瘤分别于γ刀术后5、27和63个月增大,总体肿瘤控制率为92.9%(39/42)。肿瘤平均边缘剂量13Gy,以50%～80%等剂量曲线包绕靶区。结论γ刀放射治疗对直径小于50mm三叉神经鞘瘤有良好的中长期控制作用,肿瘤控制剂量为13～14Gy。     

颅内非听神经性神经鞘瘤的放射外科治疗临床研究

目的 回顾性分析伽玛刀放射外科对非听神经性神经鞘瘤的疗效及治疗剂量.方法 应用γ刀治疗非听神经神经鞘瘤,43例获得完全随访资料,包括24例三叉神经鞘瘤和19例颈静脉孔神经鞘瘤.以50%～80%等剂量曲线包绕靶区,肿瘤中位剂量分别为13 Gy(三叉神经鞘瘤)和15 Gy(颈静脉孔神经鞘瘤).结果 43例患者平均随访时间62个月.本组随访影像提示24例三叉神经鞘瘤患者伽玛刀治疗后肿瘤基本消失的4例(16.6%),肿瘤体积明显萎缩的12例(50.0%),肿瘤体积没有明显改变的6例(25%),肿瘤体积增大的2例(8.3%),肿瘤总控制率91.7%(22/24).19例颈神经孔神经鞘瘤患者伽玛刀治疗后肿瘤基本消失的3例(15.8%),肿瘤体积明显萎缩的9例(47.4%),肿瘤体积没有明显改变的6例(31.6%),肿瘤体积增大的1例(5.3%),肿瘤总控制率94.7%.本组患者肿瘤局部控制率为93%(41/44).临床症状改善总有效率为88.4%(38/43).结论 γ刀放射外科对非听神经性神经鞘瘤有良好的中长期控制作用,毒副作用较少.     

松果体区肿瘤的伽玛刀治疗

使用立体定向伽玛刀（γ-刀）治疗松果体区肿瘤33例，肿瘤直径（X Y Z/3）10.0—45.5mm，平均23.5mm，体积0.443cm^3—35.4cm^3，平均12.1cm^3。肿瘤边缘剂量14—20Gy，平均15.2±1.7Gy。中心剂量25.0—42.8Gy，平均37.5±6.9Gy。影像定位仅为1.5T MRI。随访3—12个月。初步结果表明，病人的临床症状体征明显好转，9个月后促瘤生长控制率，即治疗有效率为96.2%，显效率92.3%，无严重并发症发生。提示γ-刀可作为松果体区肿瘤的有效治疗方法。     

Leksell—C型伽玛刀治疗听神经瘤的长期疗效分析

目的分析Leksell—C型伽玛刀治疗听神经的长期疗效。方法回顾性分析长期随访的64例听神经瘤的临床资料。其中曾行开颅手术17例．面神经功能正常53例,具备有用听力41例。肿瘤体积0．2—33．9cm^3,平均7．7cm^3;治疗周边剂量11．0-14．0 Gy,平均12．7Gy：等剂量曲线40％-60％,靶点数2～15个,平均6个。结果随访46～81个月,平均62．2个月。肿瘤缩小52例,稳定9例;肿瘤增大3例,其中2例在3年后再次行伽玛刀治疗,随访显示肿瘤缩小,另1例在治疗后2年行开颅手术。发生面神经功能损伤2例,保留有用听力29例。发生三叉神经功能障碍8例（其中一过性损伤6例,损伤率为3．1％）。结论Leksell—C型伽玛刀放射外科治疗听神经瘤具有良好的肿瘤控制率和有用听力保留率,神经功能损伤发生率低,值得临床推广应用。     

Outcomes of gamma knife treatment for solid intracranial hemangioblastomas

The aim of this study was to examine the results of gamma knife radiosurgery for 13 patients with residual/recurrent or newly diagnosed solid hemangioblastomas. The 13 patients had 34 solid hemangioblastomas, and all patients underwent gamma knife radiosurgery. Seven patients had von Hippel–Lindau disease and six had sporadic disease. When individual lesions were considered, the overall mean dose at the tumor periphery was 15.8 Gy (range: 12–25 Gy) and the average maximum tumor dose was 31.6 Gy (range: 24–50 Gy). The mean duration of follow-up with MRI was 50.2 months. At the last follow-up evaluation, growth control was achieved for all tumors (partial remission in three tumors [8.8%] and no change in 31 tumors [91.2%]). No radiation-related complications were encountered. Our findings reinforce the view that gamma knife radiosurgery is effective and safe for the management of solid hemangioblastomas with a diameter less than 3 cm, whether they are sporadic or associated with von Hippel–Lindau disease. The high response rate and lack of any radiation-induced side-effects confirms the suitability of the doses used in the present study.     

伽玛刀治疗三叉神经鞘瘤疗效观察

目的 回顾性分析评价伽玛刀对三叉神经鞘瘤的临床疗效.方法 分析2004年2月至2010年5月于本中心应用Leksell“C”型伽玛刀治疗三叉神经鞘瘤41例,其中13例为术后复发或残留,28例经MRI诊断首选伽玛刀治疗.肿瘤平均直径22 mm,肿瘤的平均体积9 cm3.照射肿瘤的平均中心剂量为29.2 Gy,平均周边剂量12.8 Gy.结果 平均随访时间38个月.症状变化:首选伽玛刀治疗的患者8例症状完全消失;18例好转,11例症状无变化或轻微加重,4例因肿瘤增大症状加重.肿瘤变化:7例肿瘤基本消失,22例肿瘤缩小,8例肿瘤未增大,4例体积增大,肿瘤控制率90.2％.结论 伽玛刀对中小型三叉神经鞘瘤治疗安全有效,有良好的中长期控制作用,并可有效地改善其临床症状,保护周围脑神经,肿瘤控制剂量为12～13 Gy.     

伽玛刀立体定向放射外科治疗脑转移瘤的疗效观察

目的探讨伽玛刀治疗脑转移瘤的近期临床疗效及不良反应。方法选择脑转移瘤患者48例（108个病灶）采用伽玛刀治疗,肿瘤周边剂量14-21Gy,平均18Gy;中心最大剂量32-40Gy,平均35.4Gy。结果对48例患者伽玛刀治疗后进行临床随访,随访时间为1-27个月,平均10个月,完全缓解8例（16.7%）,部分缓解26例（54.2%）,无变化10例（20.8%）,进展4例（8.3%）,肿瘤局部控制率为91.7%（44/48）。有神经系统症状33例患者,神经症状完全缓解11例（33.3%）,部分缓解21例（63.6%）,所有患者KPS评分均有上升。平均生存期17.4个月,未出现严重不良反应。结论伽玛刀治疗脑转移瘤具有疗效好、安全的优势,能有效提高脑转移瘤患者生活质量,延长生存期。     

颅底脑膜瘤的伽玛刀治疗

目的:评估伽玛刀(γ-刀)在治疗颅底脑膜瘤中的作用。方法:采用30％～60％等剂量曲线覆盖肿瘤,平均边缘剂量13.5Gy(10～16Gy),中心剂量32 Gy(20～45Gy) 治疗顿底啮膜瘤49例结果:平均随访15个月,17例病人保持或改善了治疗前的神经功能状态,4例加重;37例病人的影像学随访,14例肿瘤体积无变化,20例缩小,3例增大,肿瘤生长控制率达92％(34/37)。结论:早期随访结果提示γ-刀是治疗颅底脑膜瘤安全有效的手段。     

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.     

伽玛刀治疗松果体区肿瘤

目的 探索伽玛刀治疗松果体区肿瘤的具体方法，进一步提高其疗效。方法 使用伽玛刀治疗松果体区肿瘤42例，肿瘤边缘剂量10-15Gy，平均14.1Gy，中心剂量24-37.5Gy，平均30.2Gy。随访4个月-3年。结果 肿瘤消失19例，明显缩小13例，缩小7例，肿瘤不变3例，均无特殊并发症。结论 伽玛刀是治疗松果体区肿瘤的一种安全有效的方法，对有明显梗阻性脑积水，可先行脑脊液分流术再行伽玛刀治疗。     

伽玛刀治疗三叉神经鞘瘤52例临床分析

目的从影像及临床表现两方面评估伽玛刀治疗三叉神经鞘瘤的效果。方法应用γ刀治疗三叉神经鞘瘤52例,发病年龄18～77岁,平均47.1岁。20例(38.5%)为开颅手术后复发或残留,32例(61.5%)根据典型的MRI影像学表现进行诊断。面部麻木29例(55.8%),咀嚼无力11例(21.2%),继发三叉神经痛10例(19.2%),复视4例(7.7%)。52例中以实质性为主44例(84.6%),囊实混合性8例(15.4%)。其中2例囊实混合型肿瘤先行立体定向肿瘤囊液抽吸内放疗术,然后重新行核磁定位行伽玛刀治疗。肿瘤体积平均7.2cm3(0.5～38.2cm3)。肿瘤周边剂量11～17Gy,平均13.9Gy;等剂量曲线平均为47.9%。结果随访的最短时间为12个月,最长时间为156个月,平均61个月。从临床症状上看,35例(67.3%)治疗后症状明显好转或消失,14例(26.9%)同治疗前,2例(3.8%)加重。肿瘤变化:本组随访影像显示伽玛刀后肿瘤基本消失的8例(15.4%),肿瘤体积萎缩的32例(61.5%),体积较伽玛刀前无明显改变的9例(17.3%),体积增大的3例(5.8%),肿瘤总控制率94.2%(49/52)。结论γ刀治疗三叉神经鞘瘤安全有效,并可有效改善其临床症状。     

Preliminary Report of Multisession Gamma Knife Radiosurgery for Benign Perioptic Lesions: Visual Outcome in 22 Patients

Objective

Radiosurgery may be contraindicated for lesions adjacent to the optic pathways because of the substantial risk of visual complication. Multisession radiosurgery has been tried as a compromise between single session radiosurgery and fractionated radiotherapy. The purpose of this study is to evaluate the outcomes of multisession gamma knife radiosurgery (GKRS) in 22 patients with perioptic lesions of benign pathology.

Methods

In all 22 cases, the lesions were within 1 mm of the optic apparatus and were therefore not considered suitable for single session radiosurgery. Radiation was delivered in 3 to 4 fractions with a median cumulated marginal dose of 20 Gy (range, 15-20 Gy).

Results

During a mean follow-up of 29 months (range, 14-44 months), tumor control was achieved in 21 patients. Visual function improved in 7 patients, remained unchanged in 14 patients, and deteriorated in 1 patient with tumor progression. No other complication was observed.

Conclusion

This preliminary result supports the idea that multisession GKRS may be an effective and safe alternative for treatment in perioptic lesions that are unsuitable for single session radiosurgery.     

Gamma knife radiosurgery for glomus jugulare tumors: therapeutic advantages of minimalism in the skull base

Context: Glomus jugulare (GJ) tumors are paragangliomas found in the region of the jugular foramen. Surgery with/without embolization and conventional radiotherapy has been the traditional management option. Aim: To analyze the efficacy of gamma knife radiosurgery (GKS) as a primary or an adjunctive form of therapy. Settings and Design: A retrospective analysis of patients who received GKS at a tertiary neurosurgical center was performed. Materials and Methods: Of the 1601 patients who underwent GKS from 1997 to 2006, 24 patients with GJ underwent 25 procedures. Results: The average age of the cohort was 46.6 years (range, 22-76 years) and the male to female ratio was 1:2. The most common neurological deficit was IX, X, XI cranial nerve paresis (15/24). Fifteen patients received primary GKS. Mean tumor size was 8.7 cc (range 1.1-17.2 cc). The coverage achieved was 93.1% (range 90-97%) using a mean tumor margin dose of 16.4 Gy (range 12-25 Gy) at a mean isodose of 49.5% (range 45-50%). Thirteen patients (six primary and seven secondary) were available for follow-up at a median interval of 24 months (range seven to 48 months). The average tumor size was 7.9 cc (range 1.1-17.2 cc). Using a mean tumor margin dose of 16.3 Gy (range 12-20 Gy) 93.6% coverage (range 91-97%) was achieved. Six patients improved clinically. A single patient developed transient trigeminal neuralgia. Magnetic resonance imaging follow-up was available for 10 patients; seven recorded a decrease in size. There was no tumor progression. Conclusions: Gamma knife radiosurgery is a safe and effective primary and secondary modality of treatment for GJ.     

射波刀分次治疗海绵窦血管瘤的初步结果

目的 总结射波刀分次治疗海绵窦血管瘤( CSH)的初步经验.方法 应用射波刀治疗海绵窦血管瘤20例,肿瘤最大径为23.0～67.0 mm,平均42.0 mm.肿瘤平均体积为25.4 cm3.1例肿瘤照射1次,3例照射2次,其余16例肿瘤照射3次,周边剂量分别为13 Gy/1次;17.8～19.0 Gy/2次;18.4 ～21.0 Gy/3次.随访时间为7-36个月(平均15个月).结果 5例巨大肿瘤射波刀治疗后有轻微的症状加重,需要脱水治疗.所有患者均未出现新的脑神经受损症状.4例视力受影响者治疗后6个月改善,12例其他脑神经受损者症状改善或恢复正常.4例肿瘤缩小90％以上,9例缩小50％以上,4例缩小30％左右,1例未缩小,2例未复查MRI,但是症状改善.结论 射波刀治疗CSH的不良反应轻,初步疗效满意.对大型或巨大CSH,射波刀分次照射可成为其主要治疗手段之一.