听神经瘤伽玛刀术后邻近颅神经病损的研究

目的 :探讨听神经瘤伽玛刀术后邻近颅神经并发症发生率及相关因素。方法 :回顾研究 5 8例行伽玛刀治疗后随访时间 12～ 2 6个月 (中位数 18个月 )的听神经瘤患者 ,用多变量Logistic回归分析和单变量卡方检验评价听神经瘤邻近颅神经病损的相关因素。结果 :伽玛刀术后肿瘤控制率为 94 9% ,三叉神经病损发生率为 2 0 % ,桥脑岩骨距≤ 1cm患者中无一发生术后三叉神经病损 ;面瘫发生率为 10 3% ,管内外肿瘤横截面最大径≤ 2cm患者中无一发生术后面瘫 ,术前 2 4例轻中度聋患者 ,术后 2 9 2 %仍保持在轻中度聋。结论 :伽玛刀治疗听神经瘤具有极高的肿瘤控制率 ,术后肿瘤邻近颅神经并发症低 ,术后神经病损发生可能与神经被照射的长度有关。

The clinical study of cranial nerve neuropathology after gamma knife treatment of acoustic neurinoma

Objective:To evaluate the incidence of cranial nerve complication and the relative factor after gamma knife treatment of acoustic neurinomas. Method:We reviewed 58 patients with acoustic neurinomas treated by gamma knife,following-up ranged from 12 to 26 months (media,18 month).Multivariate logistic regressin analyses and univariated chi-square test were used to evaluate the relative factor of cranial nerve neuropathology.Result:The total control rate was 94.4%.The incidence of developed trigeminal and facial neuropathy was 20% and 10.3%,no delayed trigeminal neuropathy has yet developed in those patients with pon-petrous distance less than 1 cm,no delayed facial neuropathy has yet developed in those patients with mid-porous transverses diameter less than 2 cm.Useful hearing preservation was obtained in 29.2% of cases.Conclusion:The rate of tumor control was very high and the incidence of cranical nerve neuropathy was low.The cranial nerve neuropathy may be relation to the estimated length of cranial nerve irradiated.