听神经瘤的γ—刀治疗（附119例随访报告）

目的 评价伽玛刀（γ－刀）治疗听神经瘤的疗效。方法 用Leksell B型γ-刀治疗听神经瘤119例，并随访1－5年。扫描定位用1．5Tesla磁共振仪，剂量规划系统为γ-plan4.0版。肿瘤体积0．02－20．8cm^3；周边剂量9－17Gy，平均13Gy；中心剂量18－45Gy，平均32Gy；靶点数2－10个，平均4个。结果 肿瘤体积缩小95例（80％），其中显效16例（13％，指体积缩小超过75％），无变化14例（12％），增大10例（8％）。61例（51％）听力有保存，11例（9％）听力有改善；5例半年后出现面瘫，1列持续5周后消失，2例经再次手术后好转，另有2例有永久面瘫；3例病人出现三叉神经痛，2例为一过性，1例服药好转。结论 γ-刀治疗对听神经瘤具有良好的控制生长作用，尤其适合体积＜6．5cm^3及不宜开颅手术的病人，对颅神经的损伤风险低，是一种安全有效的治疗方法。

Gamma knife radiosurgery for acoustic neuroma

Objective To assess the results of gamma knife surgery for acoustic neuroma, Method Leksell-B model gamma knife was used to treat the patients with acoustic neuroma in 119 cases and followed-up from 1 to 5 years. 1.5 Tesla MRI was used for scanning and locating. Dose planning system was V-plan 4.0 version. Tumors ranged in volume from 0.02 to 20.8cm3; in targets, from 2 to 10 shots, mean 13 Gy; in center dose, from 18 to 45 Gy, mean 32 Gy; in targets, from 2 to 10 shots, mean 4. Result A decrease in volume was observed in 95 cases (80%), no change in 14 (12%), and an increase in 10 (8%). The decrease in size more than 75% were seen in 16 cases (13%). During the follow-up period, hearing deteriorated in 47 cases (40%), 11 cases showed an improvement in hearing. 5 patients had facial parests, in one case it was transient, lasting 5 weeks; in two cases there were mostly recovery after open surgery; and in other two cases it were persistent. 3 patients experienced trigeminal dysfunction; in two cases it were transient and in the other one it was persistent, although there has been improvement by treatment. Conclusion Gamma knife surgery should be used to treat acoustic neuromas which volumes less then 6.5cm3 as well as tumors in patients with sesious medical conditions during aurgery. It can control tumors growth and to reduce the risk of cramal nerve injury.