显微外科手术及伽玛刀治疗Ⅱ型神经纤维瘤病(附68例报告)

目的探讨显微外科手术及伽玛刀治疗Ⅱ型神经纤维瘤病的疗效。方法回顾分析68例NF2患者资料,68例患者中的35例至少有1个肿瘤直径>3cm,存在脑组织受压,神经功能受损,先行显微外科手术治疗,术后补充伽玛刀治疗;另外33例肿瘤最大直径<3cm,直接行伽玛刀治疗。伽玛刀治疗分次或单次进行,剂量:肿瘤中心剂量25～32Gy,边缘剂量12～16Gy,平均14Gy。结果68例患者随访6个月至58个月。伽玛刀治疗组肿瘤控制有效率为87.5%,33例患者均保留不同程度听力,新出现面瘫1例,占3%。无瘫痪、失明等并发症,无死亡,33例中1例因梗阻性脑积水行右侧脑室-腹腔分流术,2例因肿瘤明显增大行手术全切除肿瘤,2例凸面脑膜瘤因顽固性脑水肿行手术全切除肿瘤。手术结合伽玛刀治疗组35例肿瘤控制有效率为96.6%。除1例术前双侧听力均丧失者,其余患者至少保留一侧不同程度听力,治疗前伴有癫痫症状的3例患者中2例好转,1例无变化,新发癫痫1例,新发永久性面瘫5例,占14.3%,瘫痪2例,真性球麻痹1例,新发共济失调2例,死亡2例。结论肿瘤直径小于3cm,可采用伽玛刀治疗。肿瘤直径大于3cm,先手术治疗。对于凸面或镰旁脑膜瘤,无论大小,都应手术治疗。残余肿瘤可补充伽玛刀治疗。

The treatment of microsurgery and gamma-knife in NF2 (68 cases report).

Objective To explore microsurgery and gamma-knife in NF2. Methods Review the data of 68 NF2 patients. At least one of the tumor's diameter were big than 3 cm in 35 cases,they oppressed brain tissue and damaged nerve. First they were treated by microsurgery,then treated by gamma-knife. The diameter of tumor was little than 3 cm in 33 cases,they were undertook by gamma-knife only. Gamma-knife could do in one time or in many times. The center dose was 25-32 Gy,the edge dose was 12-16 Gy,average dose was 14 Gy. Results The follow up periods were 6 months to 58 months. The tumor control rate was 87.5% in gamma-knife team. No patient lost their hearing,1 case(3%)was facial paralysis. No blindness,paralysis and died. In gamma-knife team,1 case was undertook right V-P shut because hydrocephalus,Acoustic neuronal were total resected in 2 case because the tumor increasing up. Convexity meningioma were resected in 2 cases because permanence edema. The tumor control rate was 96.6 percent in operation add gamma-knife team. Except 1 case whose bilateral audition losing preoperation,the other patients kept the unilateral hearing. There were 1 epilepsy,5 facial paralysis,2 paralysis,2 ataxia,1 bulbar paralysis,2 died postoperative in operation add gamma-knife team. Among 3 patients accompanied by epilepsy,2 improved,1 no changed.Conclusions The tumor's diameter little than 3 cm could be treated by gamma-knife. If the tumor's diameter was big than 3 cm,it should be operate first. The convexity meningioma or cerefalx meningioma should be resected first whatever big or small,then treat the remains by gamma-knife.