立体定向内放疗联合γ-刀治疗复发性颅咽管瘤

目的评价立体定向穿刺引流加内放疗结合γ-刀治疗复发性颅咽管瘤的有效性和安全性。方法回顾性分析26例手术后复发性囊实性颅咽管瘤的治疗经验。对16例肿瘤实体部分靠近视神经、视交又及视束者，先行立体定向穿刺抽吸加核素内放疗，再行γ-刀治疗；对10例肿瘤囊性部分靠近视神经、视交又及视束者，先行γ-刀治疗，再行穿刺抽吸加核素内放疗。结果随访6～42个月，平均24．5个月；临床症状和体征消失10例，改善13例，无变化2例，加重1例。影像学检查结果显示病变消失4例，缩小17例，无变化3例。增大2例；有效控制率为92．3％。结论对复发性囊实性颅咽管瘤联合应用立体定向穿刺抽吸引流、^32P内放疗及γ-刀等治疗手段，具有并发症少，复发率及病死率低等优点。

A combination of stereotactic intracystic radiotherapy with Gamma knife surgery for relapsing cystosolid craniopharyngiomas

Objective To evaluate the efficacy and safety of the combination treatment with stereotactic intracavitary irradiation and Gamma knife surgery for postoperative recurrent cystosolid craniopharyngiomas. Methods Treatment experiences of 26 patients with postoperative recurrent cystosolid craniopharyngioma were analyzed retrospectively. Sixteen patients whose solid part of the tumor was close to the optic nerve, optic chiasm and optic tract were treated with stereotactic interstitial radiation, followed by Gamma knife surgery; and for the other 10 whose cyst part of the tumor close to the optic nerve, optic chiasm and optic tract, Gamma knife surgery were applied for the solid part of the tumor and then stereotactic cystic fluid aspiration and intracavitary brachytherapy were performed for the cystic part. Results Patients were followed up from 6 to 42 months, mean 24.5 months. Clinical symptoms and physical signs disappeared in 10 cases, improved in 13, unchanged in 2, and worsened in 1. Imaging examination showed tumors disappeared completely in 4 cases, shrank in 17, unchanged in 3, and enlarged in 2. The control rate of tumor was 92.3% in total. Conclusion The combination of stereotactic puncturing and aspirating cystic fluid, ^32P intracavitary irradiation and Gamma knife surgery can successfully control tumors, and offer a safe and effective means for treating postoperative recurrent cystosolid craniopharyngiomas.