立体定向穿刺引流联合伽玛刀治疗囊性脑转移瘤  

Stereotactic aspiration combined with gamma knife radiosurgery for cystic brain metastasis

作　　者：刘琨[1] 刘宜东[1] 张静华[1] 宗建海[2] 陈成雨[1] 刘华锋[2] 

机构地区：[1]济宁医学院第二附属医院神经外科伽玛刀中心,济宁272051 [2]第四军医大学唐都医院神经外科伽玛刀中心,西安710038

出　　处：《中国微创外科杂志》2007年第7期656-658,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨立体定向穿刺引流联合伽玛刀治疗颅内囊性转移瘤的临床效果。方法 本组21例囊性脑转移瘤患者,男16例,女5例,平均年龄64.5岁（45～78岁）;囊性转移病灶数目为单个19例,2个2例;病灶平均直径36 mm。卡氏（KPS）评分≥50分。采用CT定位导向穿刺引流囊液后,再用MASEP-SRRS旋转式伽玛刀进行伽玛刀治疗,覆盖病灶边缘等剂量曲线为40%～65%,平均50%;边缘剂量16～22 Gy,平均19.5 Gy。结果 治疗后1～3个月（平均2.3月）行CT或MRI检查,肿瘤完全消失12个病灶,缩小〉50%9个病灶,肿瘤实质变化〈10%及增大各1个病灶。病灶周围脑坏死及脑水肿各1例,未见其他严重并发症。局部肿瘤控制率为95.7%（22/23）。临床随访6～36个月,平均23.5月,症状明显改善18例,无改善2例,加重1例。半年生存率90.5%（19/21）,1年生存率62.5%（10/16）,2年生存率25%（3/12）,3年以上存活1例。中位生存期14.1月。结论 立体定向穿刺引流联合伽玛刀是颅内囊性转移瘤理想的微侵袭治疗方法。Objective To evaluate the outcome of stereotactic aspiration combined with gamma knife radiosurgery in the treatment of cystic brain metastasis. Methods The study included 21 cases of cystic brain metastasis. There were 16 males and 5 females, with their age ranged 45 -78 years old （mean, 64.5 years old）. Nineteen patients had a solitary tumor and 2 patients had two lesions. The mean diameter of tumors was 36 mm. The Karnofsky Performance Score （KPS） was ≥50%. A stereotactic aspiration was performed under CT guidance to drain the cystic fluid. Then the MASEP-SRRS gamma knife radiosurgery was performed. All brain metastasis were averagely enclosed within the 40% - 65% （ mean, 50% ） isodose shells of the radiosurgical fields with a peripheral dose of 16 - 22 Gy （ mean, 19.5 Gy）. Results All the cases were followed for 1 - 3 months （ mean, 2.3 months） with CT or MRI scanning. Tumors completely disappeared in 12 lesions, subsided in 9 lesions, changed less than 10% in 1 lesion, and enlarged in 1 lesion. Cerebral necrosis and edema adjacent to lesions respectively developed in 1 case. No other severe complications were seen. The control rate of tumor was 95.7% （22/23）. Twenty-one patients were followed for 6 -36 months （mean, 23.5 months）. The followed- up results showed improvement of symptoms in 18 cases, no change in 2 cases, and exacerbation in 1 case. The survival rate at 6 months was 90.5% （ 19/21 ）. And the 1- and 2-year survival rates were 62.5% （ 10/16 ） and 25% （ 3/12 ） , respectively. One case survived beyond 3 years. The median survival time was 14. 1 months. Conclusions Stereotactic aspiration combined with gamma knife radiosurgery is an ideal treatment for cystic brain metastasis.

关 键 词：脑转移瘤 立体定向 伽玛刀 

分 类 号：R739.4[医药卫生—肿瘤]