Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas

OBJECTIVE: To evaluate the clinical results achievable using current techniques of gamma knife stereotactic radiosurgery to treat sporadic unilateral acoustic neuromas. METHODS: A retrospective review of 234 consecutive patients treated for unilateral acoustic neuromas between 1996 and 1999, with a mean (SD) follow up of 35 (16) months. Tumour control was assessed with serial radiological imaging and by the need for surgical intervention. Hearing preservation was assessed using Gardner-Robertson grades. Details of complications including cranial neuropathies and non-specific vestibulo-cochlear symptoms are included. RESULTS: A tumour control rate in excess of 92% was achieved, with only 3% of patients undergoing surgery after radiosurgery. Results were less good for larger tumours, but control rates of 75% were achieved for 35-45 mm diameter lesions. Of patients with discernible hearing, Gardner-Robertson grades were unchanged in 75%. Facial nerve function was adversely affected in 4.5%, but fewer than 1% of patients had persistent weakness. Trigeminal symptoms improved in 3%, but developed in 5% of patients, being persistent in less than 1.5%. Transient non-specific vestibulo-cochlear symptoms were reported by 13% of patients. CONCLUSIONS: Tumour control rates, while difficult to define, are comparable after radiosurgery with those experienced after surgery. The complications and morbidity after radiosurgery are far less frequent than those encountered after surgery. This, combined with its minimally invasive nature, may make radiosurgery increasingly the treatment of choice for small and medium sized acoustic neuromas.     

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。     

立体定向放射外科治疗原发性三叉神经痛:远期并发症和疗效分析

目的探讨立体定向伽玛刀放射外科治疗原发性三叉神经痛的远期并发症和疗效。方法对伽玛刀治疗的33例原发性三叉神经痛病人进行长期随访(5～8年,平均75.7个月),记录其并发症和疼痛缓解情况。结果并发症发生率15.1%;短期随访有效率90.9%,远期有效率75.7%。结论立体定向伽玛刀治疗原发性三叉神经痛远期疗效可靠,并发症较少而且较轻微,可以作为首选的治疗方式。     

眼眶肿瘤的伽玛刀放射外科治疗

目的 总结评价Leksell伽玛刀治疗眼眶肿瘤的中长期疗效.方法 223例患者年龄4～85岁,平均(37.5±15.6)岁.男91例,女132例;125例为手术后残留或复发者,98例根据典型临床及影像表现进行诊断;肿瘤容积0.03～35.60 cm3,平均(5.4±1.9)cm3;肿瘤边缘剂量10～40 Gy.结果 随访18 - 114个月,平均(35.7±16.2)个月,肿瘤缩小129例(57.8％),无变化80例(35.9％),14例(6.3％)肿瘤增大,肿瘤控制率为93.7％;142例患者治疗后视力得到保留,其中视力提升79例,减退19例;21例曾出现一过性球结膜水肿.结论 伽玛刀治疗眼眶肿瘤可取得良好肿瘤控制率,多数患者可保留视力,并发症少,可成为眼眶肿瘤的主要治疗方法之一.     

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。     

三叉神经鞘瘤的伽玛刀治疗

目的 探讨伽玛刀治疗对三叉神经鞘瘤的临床疗效.方法回顾性分析1994年12月至2003年12月于本中心行伽玛刀治疗并随访的58例三叉神经鞘瘤,肿瘤平均体积4.6cm3,平均周边剂量13.1Gy,平均中心剂量28.3Gy.结果平均随访期42.5个月,影像随访证实4例肿瘤基本消失,34例明显萎缩,16例体积变化不明显,4例体积增大,肿瘤总控制率93%.28例患者的临床症状明显改善,23例临床症状无变化,7例临床症状持续加重.13例伴有继发性三叉神经痛的患者中,10例伽玛刀治疗后明显缓解或消失.结论伽玛刀治疗对中小型三叉神经鞘瘤安全有效,并可有效地改善其临床症状,保护瘤周颅神经的功能.     

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。     

Gamma knife radiosurgery for orbital tumors

Objective

This study was performed to investigate the radiological and functional outcomes of patients with orbital tumors treated by gamma knife radiosurgery (GKS).

Patients and methods

Fifteen patients with orbital tumors (7 meningiomas, 3 cavernous hemangiomas, 2 schwannomas, 2 metastatic tumors and 1 adenoid cystic carcinoma of the lacrimal gland) were treated. Seven patients with preserved vision and tumors located near the optic nerve were treated with multisession (3 or 4 fractions) radiosurgery. The mean tumor volume was 3695 mm³ (737–13,300). The median marginal dose was 14 Gy (13–20) in single-session radiosurgery, and the median cumulative marginal dose was 20 Gy (15–20) in multisession radiosurgery.

Results

After a mean follow-up of 20.9 months (6–50), tumor control was confirmed in 12 of 15 patients. Three patients with malignant lesions had to undergo another operation due to tumor progression. Of the 13 patients whose preoperative vision was preserved, 6 patients showed improvement in visual acuity and/or visual field, 4 patients showed no change in vision, and 3 patients showed deterioration (2 related to tumor progression).

Conclusions

As with intracranial tumors with similar pathologies, GKS may be an effective treatment option for orbital tumors. Multisession radiosurgery may be a good strategy for increasing the possibility of visual function preservation in selected cases in which the lesion is adjacent to the optic apparatus.     

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.     

伽玛刀治疗听神经瘤中、长期疗效分析

目的总结评价伽玛刀(γ刀)放射外科治疗听神经瘤的中长期效果。方法78例患者平均年龄45.0±17.9岁,男性35例,女性43例;单侧病变74例,双侧4例;20例曾行手术治疗;57例γ刀治疗前存在有用听力;肿瘤容积0.11～27.8ml,平均10.8ml;边缘剂量10～14Gy,平均12.27Gy,中心剂量21～30Gy,平均24.90Gy。结果随访22～96个月,平均58.3±22.9个月;63例(80.8%)肿瘤缩小,12例(15.4%)大小无变化,3例(3.8%)肿瘤增大;47例患者有用听力得到保留,其中13(22.8%)例较术前明显改善;3例(3.8%)出现患侧面瘫;5例(6.4%)出现三叉神经功能部分受损。结论γ刀治疗听神经瘤中、长期疗效分析显示既可控制肿瘤生长又取得较高的神经功能保留率,值得推广。     

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.     

伽玛刀治疗脑动静脉畸形的长期随访

目的 分析伽玛刀(γ-刀)治疗脑动静脉畸形(cAVM)的疗效及影响因素.方法 对1995年后cAVM接受γ-刀治疗已经3年以上,并且随访资料完全的341例患者进行总结.随访内容包括性别、年龄、部位、有无出血、是否栓塞、处方剂量、体积、照射能量、定位方法、随访时间共10项.结果 通过多因素Logistic回归模型分析发现γ-刀治疗cAVM的疗效与患者是否有脑出血病史、处方剂量、随访时间有关.本组治疗过程中出现2例囊肿;顽固脑水肿15例,其中1例直接导致死亡;再出血10例,其中3例直接导致死亡;不明原因死亡1例.结论 .γ-刀是治疗cAVM的一种有效的方法,疗效受多因素影响,并发症较小,但需要长期随访.     

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。     

Gamma knife radiosurgery for growth hormone-producing adenomas

We evaluated the endocrinological outcomes of gamma knife radiosurgery (GKS) for the treatment of growth hormone (GH)-producing pituitary adenomas. Twenty-six patients treated with GKS (median treatment [tumour] volume: 0.8 mL; median marginal radiation dose: 20 Gy) were followed for a median of 84 months. “Disease remission” was defined as either nadir levels of GH <1 μg/L during an oral glucose load, or random GH levels <2 μg/L and normal age-adjusted and sex-adjusted levels of insulin-like growth factor without pituitary suppressive medications. The remission rate was 38% (10/26) and the 5-year and 10-year actuarial remission rates were 16.9% and 47.4%, respectively. Two patients (8%) suffered hypopituitarism requiring medication, but no other serious deficits were observed. Although GKS requires a relatively long time to achieve hormonal remission, it is a very useful, long-term treatment for GH-producing adenomas. We propose that compared to continuing life-long medication, GKS is less invasive and more cost effective.     

侵袭性垂体腺瘤的伽玛刀治疗

目的 探讨伽玛刀治疗侵袭性垂体腺瘤的疗效。方法对临床确诊的126例侵袭性垂体腺瘤病人行Siemens Symphony1．5TMR扫描定位，应用Elekta TPS设计治疗规划，采用Leksell-B型伽玛刀实施治疗。结果随访4。99个月。影像学检查显示肿瘤控制率为95．2％（120例），临床症状改善率为92．9％（117例），内分泌改善率为91．7％（33例），复发率为0．8％（1例）。无远期并发症。结论伽玛刀可作为侵袭性垂体腺瘤的首选治疗方法，疗效较好。     

Gamma knife radiosurgery for intracanalicular acoustic neuromas

In the present study we reviewed our long-term experience with radiosurgery for intracanalicular acoustic neuromas. The study involved 25 patients with unilateral intracanalicular acoustic neuromas. The treatment volume was 0.07 to 0.8 cm(3) (median: 0.27 cm(3)). The marginal radiation dose used for treatment was 12 Gy for all patients. The follow-up period ranged from 36 to 132 months (mean: 89 months). The actuarial rate of tumour growth control at 5 and 10 years after radiosurgery was 96%. Hearing preservation was achieved in 16 patients (64%) and improvement (>20 dB relative to presurgical values) was noted in one patient (4%). No patients experienced post-radiosurgery facial palsy or other cranial nerve deficits. Based on our study and long-term follow-up, radiosurgery can produce high rates of tumour growth control and hearing preservation for intracanalicular acoustic neuromas, and is an alternative to surgical resection given its low level of invasiveness. When determining treatment for intracanalicular acoustic neuromas, the condition's benign natural course and the likelihood of hearing preservation must be taken into account.     

Gamma knife radiosurgery for intracranial cavernous malformations

Objectives

To analyze and evaluate the role of Gamma knife radiosurgery (GKRS) and clinical outcome in patients with intracranial cavernous malformations.

Patients and methods

The medical records of 96 patients who underwent radiosurgery at our institute were reviewed retrospectively.

Results

After a mean follow-up period of 4.3 years, 33 cases out of 44 (75.0%) with complaint of seizure had cleared or got improved, 9 (20.5%) were not improved and 2 (4.5%) got worse. Of the 100 lesions in the 96 patients, 24 (24.0%) had the lesions shrinkage on the follow-up imagings. One patient (1.6%) with symptom of headache and dizziness got worse and three patients (3.1%) presented with new cranial nerve palsy. We have compared the treatment results between different marginal dose groups and find that low marginal dose can get better therapeutic efficacy but with less complications.

Conclusion

GKRS is an effective and microinvasive treatment option for intracranial cavernous malformations.