伽玛刀治疗顽固性颞叶内侧癫后放射性脑水肿的临床分析

目的 总结伽玛刀治疗顽固性颞叶内侧癫痫后放射性脑水肿的发生情况，探讨其对治疗及对病人生活质量的影响。方法采用Leksell C型伽玛刀治疗51例顽固性颞叶内侧癫痫，根据癫痫发作特点、脑电图、PET—CT、MRI进行致痫灶定位。颞叶外侧皮质靶区边缘剂量10-12Gy，等剂量曲线40％-60％；加行同侧海马、杏仁照射，边缘剂量16—24Gy，等剂量曲线50％。结果随访时间18-96个月．平均66．7个月。出现放射性脑水肿表现45例，占88．2％；均发生在颞叶内侧。21例需要口服糖皮质激素，4例症状严重者需住院行静脉注射治疗。术后1年为放射效应高峰期，随时间延长，放射急性反应的MRI表现均得到改善，部分出现脑局部萎缩。4例严重放射性脑坏死病人均为WieserⅠ级者：5例Ⅴ级和Ⅵ级病人中仅1例出现放射性脑水肿反应。结论伽玛刀治疗顽固性颞叶内侧癫痫后出现放射性脑水肿甚至放射性脑坏死，均为正常的治疗反应，其与癫痫控制效果密切相关；给予对症支持治疗后，预后良好。

Analysis of cerebral radiative cerebral edema after stereotactic Gamma knife radiosurgery for intractable mesiotemporal epilepsy

Objective To review and analyze the cerebral radiative cerebral edema after Gamma knife radiosurgery for intractable mesiotemporal epilepsy, and evaluate its effect on therapeutic efficacy and quality-of-life. Methods Fifty-one patients with intractable mesiotemporal epilepsy were treated with Leksell model C Gamma knife. The epileptogenic focus was localized by characteristics of epileptic seizure, EEG, PET-CT and MRI. Marginal dose of 10-12 Gy to isodose line of 40-60% was delivered to the lateral temporal cortex, and 16-20 Gy to 50% to the homolateral amygdale and hippocampus. Results Follow-up time was 18-96 months, averaging 66.7 months. Favorable prognosis was seen in all the patients, and surgical procedure was not suggested. Forty-five patients （88.2%） suffered radiative cerebral edema, which all appeared in the mesiotemporal lobe, and showed peak radioactive reaction in about 1 year after the treatment. Twenty-one patients needed to be prescribed with corticosteroid hormone for oral use, and 4 needed intravenous injections for severe complaints. MRI changes during acute radiation reaction were ameliorated eventually, and local atrophy took place in some of them. The 4 patients with severe radiative cerebral edema were classified Wieser class Ⅰ, and only 1 showed radiative cerebral edema among the 5 patients with class V and Ⅵ. Conclusion After Gamma knife radiosurgery for intractable mesiotemporal epilepsy, the development of radiative cerebral edema is a normal process, which is closely related to the therapeutic efficacy, and can be improved satisfactorily by supportive treatment.