伽玛刀治疗高龄大型听神经瘤50例的11年随访分析  

Gamma knife for elderly patients with large vestibular schwannomas： 11-year follow-up

作　　者：王恩敏[1] 潘力[1] 王滨江[1] 张南[1] 董亚非[1] 戴嘉中[1] 蔡佩武[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华医学杂志》2009年第17期1189-1191,共3页National Medical Journal of China

摘　　要：目的分析伽玛刀治疗高龄大型听神经瘤的中长期疗效，探讨伽玛刀治疗大型听神经瘤的适应证。方法应用Leksell伽玛刀治疗高龄大型听神经瘤50例，肿瘤最大径为31．0～63．0mm，肿瘤平均体积为（14．8±8．0）cm^3。照射肿瘤的中心剂量为22．0～28．0Gy，平均周边剂量为（12．3±0．9）Gy。随访时间为68～138个月。结果46例健在，4例死亡。伽玛刀术后45例肿瘤缩小，2例无变化，3例增大，肿瘤控制率为94％（47／50）。14例保留有效听力，其余听力无变化或下降。2例出现轻度面瘫，18例出现面部不适或麻木，7例出现脑积水行分流手术。结论伽玛刀对高龄、脑干受压不明显、肿瘤内有部分囊性变的大型听神经瘤（最大径≤40mm）有良好长期控制作用。Objective To evaluate the effect of Leksell Gamma Knife （LGK） on elderly patients with large vestibular schwannomas （VS） and to summarize the indications for LGK in patients with large VS. Methods From July 1994 to July 2000, 50 elderly patients （age range： 60.0-81.0 years） with large VS were treated by LGK as primary treatment modality. The maximal tumor diameter ranged from 31.0 to 61.0 mm [ mean, （36.0 ± 6.1 ） mm ] and mean tumor volume was （ 14.8 ± 8.0） cms （ range, 7.5-54.0 cm3 ）. The maximal dose irradiated to tumor ranged from 22.0 to 28.0 Gy [ mean： （25.0 ± 1.6） Gy] and the mean tumor marginal dose was （ 12.3 ± 0.9） Gy （ range, 9.5-14.0Gy）. The mean follow-up duration was （ 86 ±12） months （range： 68-138 months）. Results Of the 50 patients with follow-up data, 4 were deceased and 46 survived. Two patients with giant VS died at 6 and 9 months post-LGK respectively because of tumor swelling. Another two patients died of stroke or heart attack at 3 years and 4 years after LGK respectively, but their tumors decreased in volume. Clinical response： hearing： 14 （28%） patients preserved useful hearing as pre-LGK; 32 patients had unchanged or deteriorated hearing. Facial palsy： two patients developed mild facial palsy at 4 and 8 months respectively, one of them recovered and another improved later. Seven patients developed hydrocephalus around 6 months post-LGK and had V-P shunt. Eighteen patients had deteriorated facial numbness because of tumor swelling, 15 of them improved 3 years later. Tumor response ： in 46 surviving patients, 43 tumors decreased markedly in size, 2 tumors remained stable in volume, 1 tumor progressed at five years and had second LGK. In this series tumor control rate was 94% （47/50）. Conclusion LGK provides an effective treatment for some selected large VS （maximal diameter ≤40 mm） in elderly patients, especially when the brain stem compression was not obvious and VS had non-enhanced area or small cysts within the t

关 键 词：听神经瘤 伽玛刀外科 老年人 

分 类 号：R686[医药卫生—骨科学]