伽玛刀治疗听神经鞘瘤的MRI随访及临床分析  

MRI follow-up and clinical analysis for postradiosurgical acoustic neuromas

作　　者：孙时斌[1] 刘阿力[1] 罗斌[1] 王美华[1] 刘鹏[1] 

机构地区：[1]北京市神经外科研究所伽玛刀室,100050

出　　处：《中华放射学杂志》2004年第10期1042-1046,共5页Chinese Journal of Radiology

摘　　要：目的　探讨伽玛刀治疗对听神经鞘瘤的疗效及MRI随访的影像特点。方法　从 1994年 12月至 2 0 0 2年 12月 2 4 9例听神经瘤患者的 2 5 6个瘤灶于本中心行伽玛刀治疗并行MRI随访 ,平均临床随访期 2 6 4个月 (6～ 10 1个月 ) ,平均MRI随访期 2 2 4个月 (6～ 93个月 )。结果　 2 5 6个瘤灶中 79个体积缩小 (30 8% ) ,16 5个体积改变不明显 (6 4 5 % ) ,12个体积扩大 (4 7% ) ,肿瘤总控制率95 3%。听力下降率 2 2 7% ,永久面瘫率 0 0 % ,一过性面瘫率 5 9% ,一过性三叉神经功能障碍19 9%。伽玛刀治疗后神经鞘瘤常表现中心失增强反应 ,并伴发瘤灶的一过性肿胀 ,需与肿瘤的再生长相鉴别。结论　伽玛刀治疗对较小体积的听神经瘤有良好疗效 ,对面听神经功能有明显保留作用 ,对NFObjective To assess the effect of the gamma knife radiosurgery (GKS) for acoustic neuromas, and to analyze the MRI features of the tumors after GKS. Methods GKS was performed in 309 patients with acoustic neuromas from December 1994 to December 2002 at our center. The Leksell Gamma Knife models B and C were used. 249 cases with 256 tumors were followed up with MRI, which included 107 males and 142 females. The median age of the patients was 48.7±14.2 years (10-77 years). GKS was applied as primary treatment for 189 cases (75.9%), and was an adjunctive management approach for 60 cases (24.1%). The median clinical follow-up period and radiological follow-up period was (26.4±21.3) months (6-101 months) and (22.4±19.0) months (6-93 months), respectively. Results Of the 256 tumors, 79 tumors (30.8%) regressed, 165 tumors (64.5%) remained stable, 12 tumors (4.7%) enlarged, and the overall tumor control rate was 95.3%. Among 30 tumors of NF-Ⅱ , 8 tumors (26.6%) regressed, 19 tumors (63.4) remained stable, and 3 tumors (10.0%) enlarged, and tumor control rate was 90%. The rate of hearing deterioration was 22.7%, the rate of permanent facial paralysis was 0%, the rate of transient facial paralysis was 5.9%, and the incidence of transient trigeminal neuropathies was 19.9%. On the image of follow-up MRI, 79 tumors (30.0%) showed loss of contrast enhancement (LOE). LOE was the imaging property of neuromas on follow-up MRI, which symbolized a chronic decrease in the vascularity of neuromas. The histological findings of LOE demonstrated radiation-induced tumor necrosis. The transient swelling of tumors could not be confounded with the growth of tumors. Conclusion GKS is confirmed to be an effective treatment for acoustic neuromas and plays an important role in the control of NF―Ⅱ, and GKS can prevent cranial nerve from injury to a great extent.

关 键 词：伽玛刀治疗 MRI 随访 听神经鞘瘤 一过性 肿瘤 面瘫 小体积 并行 平均 

分 类 号：R739.4[医药卫生—肿瘤]