伽玛刀治疗脑部疾患晚发灶周水肿原因探讨  

Discussion of the Causes of Perifocal Edema Occured Laterly After Gamma Knife Therapy

作　　者：罗汉超[1,2] 徐梓榕[1,2] 孔祥泉[1,2] 郑金龙 肖学宏[1,2] 冯阳宁 冯丽红[1,2] 

机构地区：[1]同济医科大学附属协和医院放射科 [2]广东省肇庆市第二人民医院放射科

出　　处：《临床放射学杂志》1998年第5期264-266,共3页Journal of Clinical Radiology

摘　　要：目的：探讨伽玛刀治疗后晚发灶周水肿的原因，从而为临床预防及治疗提供依据。材料与方法：伽玛刀治疗后不同程度晚发灶周水肿患者２２例，临床资料齐全及影像资料完整，其中转移瘤２例，胶质瘤７例，脑膜瘤５例，血管畸形７例，帕金森氏病１例（其中４例为院外作伽玛刀治疗），３例用了ＭＲＡ复查（院外），全部病例术前ＭＲＩ图像上均无明显水肿。于治疗后２～１２个月行ＭＲＩ复查。灶周水肿程度分为轻、中、重度。结果：轻度水肿５例，其中胶质瘤４例，转移瘤１例；中度水肿８例，其中血管畸形４例，胶质瘤３例，转移瘤１例；重度水肿９例，其中脑膜瘤５例，血管瘤３例，帕金森氏病１例。结论：产生灶周水肿的原因是多方面的，与病灶大小及照射剂量似有一定关系。笔者根据一些特定部位及血管畸形治疗后易发生水肿的特点。Objective: To Explore the causes of perifocal edema after gamma knife therapy and provide evidence for clinical prevention and treatment.Materials and Methods:22 patients had undergone gamma knife therapy included metastasic tumor (n=2), glioma (n=7), meningioma (n=5), arteriovenous malformation (AVM, n=7) and Parkinson's disease (n=1). All patients had clinical and imaging data. All the patients showed no apparent edema in MR imaging before the therapy and re examined with MR imaging 2～12 months after the therapy. The intensity of edema was divided into mild, intermediate and severe.Results:Mild edema, including glioma (n=4) and metastastic tumor (n=1), intermediate edema, including AVM (n=4), glioma (n=3), metastastic (n=1), severe edema, including menongioma (n=5), hemangioma (n=3) and Parkinson's disease (n=1) were seen in the MR images.Conclusions: There were multiple factors to cause perifocal edema. They seemed to be related to the size of the foci and dose of radiation. On the basis of some special affected sites and the propensity to edema after therapy, we presumed that occlusion of the draining vein and autoimmunity induced by absorption of necrostic tissue after the radiative therapy were also involved.

关 键 词：伽玛刀治疗 脑水肿 脑疾病 放射疗法 

分 类 号：R742.05[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]