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。

Gamma knife radiosurgery for craniopharyngiomas

Objective To evaluate the long-term effects and safety of gamma knife radiosurgery in the treatment of craniopharyngiomas.Methods Clinical data of 25 patients with craniopharyngiomas treated by Leksell gamma knife were analyzed retrospectively,including 5 solid tumor patients,9 cystic tumor ones and 11 mixed tumor ones,and the tumor volume ranged from 0.22 to 16.2 cm3.The fractionated radiotherapy was performed in 5 patients with marginal dose of 6 to 8 Gy and 50% isodose curve.The single radiotherapy was performed in 20 patients with marginal dose of 10 to 15 Gy and 35% to 50% isodose curve.The exposure dose of the optic nerve and optic tract was limited to less than 10 Gy.Results All the patients were followed up for 5 to 139 months,and the clinical symptoms were improved to varying degrees.MRI examination showed that the tumors disappeared in 5 patients,decreased in 13,unchanged in 3,cystic fluid appeared repeatedly in 4 and got better after the fluid was aspirated with Omamaya bag.Conclusions Gamma knife radiosurery is a safe and effective means for craniopharyngiomas,and can be the first opinion for small solid tumors,cystic tumors that can treated by aspiration and residual tumors after the operation.