伽玛刀联合立体定向手术治疗颅内囊性肿瘤

目的探讨立体定向穿刺抽吸手术与伽玛刀联合治疗颅内囊性肿瘤在立体定向放射外科治疗中的作用。方法分析颅内囊性肿瘤40例，单纯立体定向穿刺抽液19例，留置Ommaya囊抽液19例，内窥镜下手术切除肿瘤并排除囊液2例。肿瘤体积缩小后再行立体定向磁共振成像（MRI）定位、伽玛刀治疗，并计算抽液前后肿瘤体积的变化。依据Logistic综合方程计算抽液前后风险概率的变化，将抽液前后的肿瘤体积和风险概率进行配对t检验。结果抽液后瘤囊完全消失，病灶体积明显缩小。抽液前后肿瘤容积和风险概率均显著降低（容积变化：t＝8.108，P＜0．001；风险概率：t＝5．933，P＜0．001）。随访时间6个月～42个月，平均17.5个月。经伽玛刀治疗后，瘤结节消失10例，缩小12例，无变化17例，增大1例。结论颅内囊性肿瘤立体定向穿刺抽液后肿瘤体积缩小，使立体定向放射外科治疗并发症的风险概率显著降低，是联合伽玛刀治疗囊性肿瘤一种有效方法；针对肿瘤病理类型的不同采用伽玛刀放射外科联合单纯穿刺或置管抽取囊液、结合囊内治疗是囊性肿瘤治疗成功的关键。

Treatment of intracranial cystic tumors in stereotactic surgery combined with gamma knife radiosurgery

Objective To evaluate the potential role of stereotactic aspiration combined with gamma knife radiosurgery for intracranial cystic tumor. Method 40 consecutive patients with intracranial cystic tumor were treated in stereotactic surgery combined with gamma knife radiosurgery. Of total series, single stereotactic aspiration were performed in 19 cases, stereotactic aspiration with Ommaya reservoir implantation in 19 cases, stereotactic endoscopic surgery in 2 cases. Gamma knife radiosurgery was performed after intracystic content aspirated. The total tumor volume were grouped into both pre-aspiration and post-aspiration, and the corresponding risk probability analysised by integrated logistic formula. Difference between the two groups were measured by paired-test. Result After stereotactic aspiration, both cysts disappearence and tumor volume diminution in all 40 patients, statistic results demonstrated signifieant differences between the two groups of volume (P <0.001) and risk probability groups (P <0.001), respectively. Follow-up ranged from 6 to 42 months (mean 17.5 months), the image study revealed tumor disapearence in 10 cases, deminished in 12 cases, remained stable in 17 cases, increased in 1 case. Conclusion Stereotactic aspiration combined with. gamma knife radiosurgery is an effective method for intracranial cystic tumors, the selection of stereotactic procedures which depend on the tumor's pathological type may be of great importance.