143例功能性垂体微腺瘤的X-刀治疗分析

背景与目的：长期以来神经外科经蝶入路手术切除是治疗功能性垂体微腺瘤的主要方法之一,近年来由于放射外科技术的发展,给神经外科医生们提供了新的治疗功能性垂体微腺瘤的方法。本研究旨在探讨X—刀放射外科技术治疗功能性垂体微腺瘤效果。方法：1996年6月至2001年6月我们应用X—刀治疗垂体微腺瘤143例,其中泌乳素(Prolactin,PRL)腺瘤73例、生长激素(grouth hormone,GH)腺瘤54例、促肾上腺皮质激素(adrenal conticotropin hormone,ACTH)腺瘤13例、混合性(GH PRL)腺瘤3例。所有病例均为单个等中心单次治疗。结果：X—刀治疗后,随访3—60个月,中位随访时间38．4月。除失访的31例外,随访到的112例患者中,显效78例(69．7％),有效10例(8．9％),无变化19例(16．8％),进展5例(4．6％)。结论：使用X—刀放射外科治疗功能性垂体微腺瘤是一种安全和有效的方法。

Analysis of the results of 143 cases of pituitary micro-adenoma treated by Linac X-Knife stereotactic radioneurosurgery

BACKGROUND &OBJECTIVE: The trans sphenoid surgery was one of the main methods for the treatment of functional pituitary micro adenoma for many years, while the development of radiosurgical techniques in recent years has given neurosurgeons new ways to treat functional pituitary micro adenoma. This report aimed to ascertain the effectiveness of X Knife stereotactic radioneurosurgery on pituitary micro adenoma. METHODS: From June 1996 to June 2001, 143 cases of functional pituitary micro adenoma were treated by X Knife radiosurgery, in which 73 cases of secreting prolactin (PRL),54 cases of secreting growth hormone(GH), 13 cases of secreting adrenal corticotrophin hormone (ACTH), and 3 cases of secreting both PRL and GH. The radiosurgical procedure included local anesthesia administration, head ring mounting, serial thin slice CT scanning with contrast enhancement, CT image transfer, treatment planning on the computer workstation, stereotactic localization of the target onto the Linac isocenter, and then the Linac was used to perform multiple non coplannar arc radiation. All cases received single fraction radiosurgery. RESULTS: After X Knife radiosurgery, follow up ranged 3 60 months (median 38.4 month). Among those 112 cases that acquired follow up, 78(69.7%) cases showed good clinical improvements, 10(8.9%) cases showed relatively good clinical improvements, 19(16.8%) cases showed no clinical improvement, and 5(4.6%) cases had progression of disease and enlargement of the adenoma. CONCLUSION: X Knife radiosurgery is a safe and effective technique for the treatment of functional pituitary micro adenoma. While for young patients, the diagnosis of pituitary micro adenoma and use of X Knife radiosurgery should be very cautious, otherwise hypopituitarism might be resulted.