伽玛治疗听神经瘤的长期疗效分 析简

目的探讨伽玛刀治疗听神经瘤长期预后的影响因素。方法回顾性分析164例接受伽玛刀治疗并随访的听神经瘤病例资料，伽玛刀治疗的平均中心剂量为20．86Gy（10～27．1Gy），平均周边剂量为10．64Gy（6～18Gy）；平均肿瘤体积为11．54cm3（0．06～100．07cm3）。记录肿瘤KOOS分级，术后病人听力，面神经、三叉神经功能及其他并发症等情况。结果随访5～86个月．平均39.3个月，术后病人无进展生存率为86．6％，听力功能保留率为82．3％。术后新出现面部麻木感3例，面瘫2例，三叉神经痛2例，病侧耳鸣4例，脑积水1例，性格改变1例，头晕22例。单因素分析提示，肿瘤体积和KOOS分级与病人预后有关（P〈0．05）。肿瘤体积大小是伽玛刀术后的独立预后因素（P〈0．05）。术前肿瘤体积和KOOS分级对伽玛刀术后病人听力保留率有显著影响（P〈0．05）。结论伽玛刀治疗听神经瘤是一种安全和有效的方法，术前肿瘤体积〈10cm3和KOOS分级较低提示病人无进展生存时间较长，术后较高听力功能保留率。

Analysis of long-term efficacy of acoustic neuroma treated by gamma knife

Objective To explore the factors influencing the long-term prognosis of acoustic neuroma treated by gamma knife. Methods Clinical data of 164 patients with acoustic neuroma undergoing gamma knife treatment were analyzed retrospectively. The mean central dose was 20.86 Gy （range 10 to 27.1 Gy）, mean margin dose was 10.64 Gy （range 6 to 18 Gy） and mean tumor volume was 11.54 cm3 （range 0.06 to 100.07 cm3）. The KOOS classification of the tumor, postoperative heating, facial nerve and trigeminal nerve function, and other complications were recorded. All the patients were followed up. Results Follow-up lasted 5 to 86 months, with an average of 39.3 months, the progression-flee-survival rate after surgery was 86.6%, hearing function preservation rate was 82.3%. The complication was facial numbness in 3 patients, facial paralysis in 2, trigeminal neuralgia in 2, ipsilateral tinnitus in 4, hydrocephalus in 1, personality changes in 1, dizziness in 22. Univariate analysis revealed that the tumor volume and KOOS classification were related with prognosis （P 〈 0.05）. The tumor volume was a dependent factor for prognosis （P 〈 0.05）. Preoperative tumor volume and KOOS classification significantly impacted the heating preservation rates of patients treated by gamma knife （P 〈 0.05）. Conclusions Gamma knife is safe and effective to treat acoustic neuroma. The preoperative tumor volume 〈10 cm3 and lower KOOS classification could result in longer progression-flee survival time and can improve postoperative heating preservation rate.