星形胶质细胞瘤伽玛刀治疗的疗效与影响因素

目的分析星形胶质细胞瘤伽玛刀(γ-刀)治疗的疗效与影响因素.方法回顾性分析48例星形胶质细胞瘤病人的γ-刀治疗结果.以性别、有无普通放疗经过、有无化疗经过、边缘剂量、病灶的平均直径、病变的病理等级、影像学上有无相对较清楚的边界为治疗结果影响因素,判定标准以病灶缩小为有效,采用logistic回归模型,确定多因素条件下治疗结果的影响因素.结果有效32例(66.7%),logistic回归模型分析表明:病理等级和病灶平均直径为与肿瘤控制有关的影响因素.结论γ-刀对星形胶质细胞瘤的治疗有一定的意义.     

X刀治疗脑内病变283例长期随访研究

目的:总结X刀治疗脑内病变的长期随访结果.方法:对283例X刀治疗的脑瘤和脑血管畸形患者进行临床和影像学随访,随访时间为1～8年,平均(2.05±4.66)年.结果:82例转移瘤消失35例(42.7％),缩小28例(34.1％),无变化11例(13.4％),增大8例(9.8％);61例胶质瘤消失10例(16.4％),缩小19例(31.1％),无变化16例(26.2％),增大16例(26.2％);55例动静脉畸形消失29例(52.7％),缩小20例(36.4％),无变化6例(10.9％);17例海绵状血管瘤缩小4例(23.5％),无变化13例(76.5％);35例脑膜瘤消失5例(14.3％),缩小15例(42.9％),无变化13例(37.1％),增大2例(5.7％);12例神经鞘瘤消失3例(25.0％),缩小6例(50.0％),无变化2例(16.7％),增大1例(8.3％);10例生殖细胞瘤消失8例(80.0％),缩小2例(20.0％);11例其他肿瘤消失2例(18.2％),缩小4例(36.4％),无变化4例(36.4％),增大1例(9.0％).影像检查还发现病灶有坏死表现99例,囊性变19例,周边环状强化73例,胶质细胞增生20例,暂时性反应性肿大23例,放射性脑水肿28例.结论:X刀对小型脑肿瘤和血管畸形是一种安全有效的治疗方法,X刀治疗的主要并发症是放射性脑水肿.     

伽玛刀治疗听神经瘤(附98例分析)

目的 评价伽玛刀治疗听神经的效果。方法 应用OUR旋转式伽玛刀治疗听神经98例。肿瘤直径512～29．7min．平均18.8mm。采用多个放射中心联合照射，周边等剂量曲线为45％-70％，边缘剂量10-13Gy。结果 81例获14。84个月随访，平均39个月。MRI示41例（50．6％）肿瘤缩小，38例（46.9％）无变化，2例（2．5％）增大；25例（30.9％）肿瘤中心失增强。无面瘫和面部麻木，听力保留率59.2％。结论 伽玛刀对听神经瘤有较高的肿瘤控制率，并能保留有用听力，对面神经、三又神经损伤小，是小至中等大小听神经瘤可供选择的治疗方法，及术后残余和复发肿瘤的重要辅助治疗手段。     

Clinical Course and Autopsy Findings of a Patient with Clival Chordoma Who Underwent Multiple Surgeries and Radiation during a 10-Year Period.

The management of clival chordoma remains problematic. We present the case of a 48-year-old woman with clival chordoma who underwent multiple surgeries and radiation therapy, including gamma knife stereotactic radiosurgery (GK-SRS), during a 10-year clinical course. The tumor was initially removed by gross total resection via the trans-sphenoidal approach, followed by external linac radiation therapy. The tumor recurred at the clivus 5 years after the initial operation. After repeated trans-sphenoidal removal of recurrent tumors, she twice underwent GK-SRS for a tumor remnant adjacent to the brainstem. Although this part of the tumor was controlled by GK-SRS, there was further tumor extension toward the sphenoid and maxillary sinuses. Ultimately, lower cranial nerve dysfunction developed due to tumor extension into the lower part of the clivus and the patient died of respiratory failure. Autopsy revealed the tumor to extend from the lower clivus to the bilateral middle fossae. The lower part of the tumor extended to the nasal cavity and to the posterior wall of the pharynx, resulting in compression of the upper pharyngeal region. The tumor around the jugular foramen compressed the lower cranial nerves bilaterally. Tumor cells did not, however, invade the intradural space microscopically. Although chordoma is not biologically malignant, this tumor can show massive extension with destruction of bony structures and extracranial invasion of connective tissues. Therefore, the optimal treatment strategy is to remove the tumor mass as extensively as possible, including normal bony structures and connective tissues surrounding the tumor, using skull base surgical techniques.     

立体定向治疗中靶心定位的算法

本文介绍了在立体定向放射神经外科中，根据病人配戴头环和ＣＴ定标架作ＣＴ扫描所得的ＣＴ断层图像或配戴ＡＶＭ定位箱做血管造影得到的两张Ｘ光片确定病人颅内病灶的三维坐标的方法。     

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).