原发性三叉神经痛的LEKSELL-C伽玛刀治疗

目的 探讨伽玛刀治疗原发性三叉神经痛的方法和效果.方法 对28例原发性三叉神经痛采用LEKSELL-C型伽玛刀治疗,均沿三叉神经走行在三叉神经根近桥脑处选择双靶点治疗.中心剂量75～85Gy,50%等剂量线限定靶点.结果 随访3～11个月,疼痛消失时间平均在术后3.5个月.按疼痛缓解评分,在随访时点,总有效率为96%.结论 LEKSELL-C型伽玛刀是治疗原发性三叉神经痛安全和有效的方法之一.     

Transarterial embolization of vein of Galen aneurysmal malformation after unsuccessful stereotactic radiosurgery

The authors present three cases of vein of Galen aneurysmal malformations (VGAMs) diagnosed in infancy and submitted by the referring teams for stereotactic radiosurgery as the initial therapy (therapeutic doses ranging between 20–25 Gy and 40–50 Gy to the peak dose). After the conventional follow-up of 18–24 months, no change could be detected in the angioarchitecture of the lesions. All three cases were then referred for endovascular treatment and underwent embolization by the transarterial route using liquid adhesives (N-butyl cyanoacrylate). This resulted in complete anatomical exclusion of the lesion. Regardless of the theoretical efficiency of radiosurgery in the management of brain arteriovenous malformations, the present authors believe that transarterial embolization remains the treatment of choice in VGAMs. It offers a high rate of morphological cure and the best chances for normal neurocognitive development. The time required by radiosurgery to achieve a significant result is too long for developing and maturing brain and may not prevent the negative effects of the lesion, mainly in regard to hemo- and hydrodynamic disorders (atrophy, subcortical calcifications, etc.) created by the VGAM, thus leading to irreversible mental retardation.     

X-刀治疗靶点定位精确度分析

目的 :研究SRS2 0 0X 刀治疗系统治疗靶点定位的精确度。方法 :应用人体头颅模型内特定标记物测定CT定位的精度 ,用胶片法测定二次等中心系统精度和总的治疗精度。结果 :BRW头环CT定位精度为 0 .65mm ,最大误差为 1 .0 9mm ;SRS2 0 0二次等中心系统误差为 0 .1 9mm ;总治疗误差理论计算值为0 .68mm ,胶片法检测值为 1 .43mm。结论 :X 刀治疗系统精确度已达到放射外科质量控制要求。     

伽玛刀治疗垂体大腺瘤临床分析(附30例报告)

目的 研究伽玛刀治疗垂体大腺瘤的效果及影响疗效的因素。方法 30例垂体大腺瘤病人用1．0T磁共振定位，Gamma-plan计划系统规划，等剂量曲线45％～60％(平均49．7％)，周边剂量12～35Gy(平均22.9Gy)，中心剂量24～70Gy(平均45．4Gy)．Leksell伽玛刀实施放射外科治疗。分析治疗后垂体大腺瘤病例，总结其疗效和影响疗效的因素。结果 随访12～60个月，平均28个月，肿瘤完全消失6例(20％)，肿瘤缩小19例(63．3％)，无变化5例(16．7％)；19／20(95．5％)功能性垂体腺瘤内分泌症状改善，临床症状好转，1例过早绝经(年龄36岁)；5／10(50％)无功能性垂体腺瘤体积缩小．症状改善。结论 伽玛刀对于垂体大腺瘤仍是一种有效的治疗方法，其疗神与腺瘤的举类型、体积、照射剂量、剂量体剂、MRI信号特征密切相姜。     

乳腺病变X线立体定位钢丝置入移位的分析

目的分析乳腺立体定位下钢丝置入移位的表现、原因、处理方法，提高术前定位的准确性。方法行立体定位置入钢丝患者79例，96个病变，发生钢丝移位13例。结果立体定位中发生钢丝移位5例，原因分别来自于患者和操作医师；立体定位完成后钢丝移位5例，原因是局麻注射药物过多，导致乳腺Z轴的深度与计算机提示的实际深度不符合、放置定位针的方法不正确、拔出钢丝外套针套时疏忽钢丝是否已锚定病变。处理方法：可按照钢丝提示位置向病变方向移位2cm以内进行手术，重新放置第2根钢丝，将双J型钢丝收入针套并取出体外，重新定位。手术中钢丝脱出2例，因术后过分提拉钢丝所致，放射科医师放置钢丝后应向外科医师准确描述深度、方向，并从距离钢丝头端距离皮肤最近处取切口手术。术后标本未见钙化1例，与钙化位于手术电刀破坏的腺体内有关，可扩大范围切除并短期复查，证实钙化是否完整切除。结论正确认识乳腺X线立体定位下钢丝移位的表现，熟练掌握其处理方法，可提高对不可触及的乳腺病变的定位准确性，正确引导外科手术。     

松果体区病灶直线加速器放射外科的剂量分布探讨

通过运用仿真人体模型对松果体区靶病灶直线加速器多聚弧照射的监测，论证直线加速器作为放射外科工具治疗颅内病变的科学性，探讨有关辐射参数对剂量分布的影响。作者认为，直线器放射外科可实现与伽玛马相似的剂量分布，同是神经外科安全有效的治疗技术，准直器孔径越小，照射范围越大，则剂量梯度即越大，剂量分布越理想；靶区最大剂量对上器孔径有相当高的依赖性，本文还就合理的照射弧范围及边缘处方剂量作了讨论。     

Gamma Knife Radiosurgery of the Glomus Jugulare Tumour – Early Multicentre Experience

Leksell Gamma Knife was used to treat 66 patients with glomus jugulare tumour at 6 European sites between 1992-1998. The age of the patients ranged between 18-80 years (median 54 years). Gamma Knife radiosurgery was a primary treatment in 30 patients (45. 5%). Open surgery preceded radiosurgery in 24 patients (36.4%), embolisation in 14 patients (21.2%) and fractionated radiotherapy in 5 patients (7.6%). The volume of the tumour ranged 0.5-27 cm(3) (median 5,7 cm(3)). The minimal dose to the tumour margin ranged between 10-30 Gy (median 16.5 Gy). After radiosurgery 52 patients were followed, the follow up period was 3-70 months (median 24 months). Neurological deficit improved in 15 patients (29%) and deteriorated in 3 patients (5,8%), one transient and two persistant. Neuroradiological follow up using MRI or CT was performed in 47 patients 4-70 months (median 24 months) after radiosurgery. Tumour size decreased in 19 patients (40%) while in the remaining 28 patients (60%) no change in the tumour volume was observed. None of the tumours increased in volume during the observation period. Control angiography was performed in 6 patients. Pathological vascularisation completely disappeared in one patient, reduced in two and there was no change in the remaining three. Radiosurgery proves to be a safe treatment for glomus jugulare tumour with no mortality and no acute morbidity. Because of its naturally slow growth rate, up to 10 years of follow up will be necessary to establish a cure rate after radiosurgery for these lesions.     

鼻咽癌初程放疗后残存的分次X刀治疗初探

目的回顾性分析分次立体定向放射外科治疗鼻咽癌放疗后残存肿瘤疗效，评价其临床应用价值。方法98例鼻咽癌放疗后鼻咽局部残存患者采用分次立体定向放射外科技术推量治疗。1992年福州分期Ⅰ期2例，Ⅱ期29例，Ⅲ期53例，Ⅳa期14例。UICC1997分期Ⅰ期2例，Ⅱa期2例，Ⅱb期27例，Ⅲ期37例，Ⅳa期2l例，Ⅳb期9例。分次立体定向放射外科治疗总剂量为12～24Gy，分次剂量为4、5、6、7、8、12Gy，间隔1～7d，1～4个中心，60％～90％参考剂量线。结果完全控制95例，无法评价3例，局部控制率为97％。1、2、3、4、5、年总生存率分别为94％、86％、82％、80％、74％。1、2、3、4、5、年无瘤生存率分别为88％、82％、80％、78％、。75％。随诊超过6年的24例中，无瘤生存14例；3例随诊满8年生存3／3，8例满7年生存．4／8，13例满6年生存7／13。结论分次立体定向放射外科治疗鼻咽癌放疗后鼻咽残存肿瘤有肯定临床价值；选择合适病例能获满意疗效；剂量分割方式有个体化特点；晚期组织损伤应引起高度重视；重视肿瘤控制与周边正常组织结构损伤与修复的平衡关系。     

Radiothérapie avec modulation d’intensité et radiothérapie stéréotaxique des tumeurs ORL : médecine fondée sur les preuves

Over the last decade, there have been many technical advances in radiation therapy, such as the spread of intensity-modulated conformal radiotherapy, and the rise of stereotactic body radiation therapy. By allowing better dose-to-target conformation and thus better organs at risk-sparing, these techniques seem very promising, particularly in the field of head and neck tumors. The present work aims at analyzing the level of evidence and recommendation supporting the use of high-technology radiotherapy in head and neck neoplasms, by reviewing the available literature.     

Comparison of management approaches in deep-seated intracranial arteriovenous malformations: Does treatment improve outcome?

Deep-seated intracranial arteriovenous malformations (AVMs) represent a subset of AVMs characterized by variably reported outcomes regarding the risk of hemorrhage, microsurgical complications, and response to stereotactic radiosurgery (SRS). We aimed to compare outcomes of microsurgery, SRS, endovascular therapy, and conservative follow-up in deep-seated AVMs. A prospectively maintained database of AVM patients (1990–2017) was queried to identify patients with ruptured and unruptured deep-seated AVMs (extension into thalamus, basal ganglia, or brainstem). Comparisons of hemorrhage-free survival and poor functional outcome (modified Rankin scale [mRS] > 2) were performed between conservative management, microsurgery (±pre-procedural embolization), SRS (±pre-procedural embolization), and embolization utilizing multivariable Cox and logistic regression analyses controlling for univariable factors with p < 0.05. Of 789 AVM patients, 102 had deep-seated AVMs (conservative: 34; microsurgery: 6; SRS: 54; embolization: 8). Mean follow-up time was 6.1 years and did not differ significantly between management groups (p = 0.393). Complete obliteration was achieved in 49% of SRS patients. Upon multivariable analysis controlling for baseline rupture with conservative management as a reference group, embolization was associated with an increased hazard of hemorrhage (HR = 6.2, 95%CI [1.1–40.0], p = 0.037), while microsurgery (p = 0.118) and SRS (p = 0.167) provided no significant protection from hemorrhage. Controlling for baseline mRS, microsurgery was associated with an increased risk of poor outcome (OR = 9.2[1.2–68.3], p = 0.030), while SRS (p = 0.557) and embolization (p = 0.541) did not differ significantly from conservative management. Deep AVMs harbor a high risk of hemorrhage, but the benefit from intervention Remains uncertain. SRS may be a relatively more effective approach if interventional therapy is indicated.