听神经鞘瘤伽玛刀治疗10年以上的长期随访  

Long term follow - up studies for postradiosurgical vestibular schwannomas

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

机构地区：[1]首都医科大学附属天坛医院,北京市神经外科研究所伽玛刀室,100050

出　　处：《中华神经外科杂志》2011年第10期975-978,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨伽玛刀治疗（GKS）单侧听神经鞘瘤的长期临床疗效。方法从1994年12月至2000年12月于天坛医院接受治疗超过10年的单侧听神经鞘瘤患者197例，随访到157例（随访率80．0％），平均年龄51．4（10—77）岁。首选GKS治疗者125例（79．6％），显微外科手术后再行GKS治疗者32例（20．4％）。平均周边剂量127Gy（8．0—14．4Gy），平均中心剂量28．8Gy（20—40Gy），治疗等中心点平均为4个（1-9个），平均体积5．1cm3。平均随访时间＆3年（1—15年），其中60例患者随访时间≥10年。结果平均随访期6．3年，157例患者中93例肿瘤体积明显皱缩（59．2％），48例肿瘤体积无明显变化（30.6％），16例出现肿瘤发展伴临床症状加重（10．2％）。肿瘤控制率89．8％，其中7例患者在随访过程中因其他病因死亡，伽玛刀控制肿瘤终生。肿瘤累积控制率3年为94％，5年为92％，10年为87％。听力累积保留率3年为94％，5年为85％，10年为64％。一过性面神经功能障碍16．6％，一过性三叉神经功能障碍17．8％，轻度面瘫1．3％，面部麻木2．5％。永久性明显的面神经及三叉神经功能障碍发生率为0.0％。结论周边处方剂量12—14Gy确实能长期控制中小体积听神经鞘瘤的肿瘤生长并保持良好的生存质量，随着随访时间的延长听力保留率有逐步下降趋势，对面神经及三叉神经功能有明显保留作用。因肿瘤的远期复发，长期随访不能终止。Objective The aim of this study was to assess the long term clinical outcomes of the gamma radiosurgery（GKS） for vestibular schwannomas （VS）. Methods Duaring the period from December 1994 to December 2000 , 197 patients with VS received GKS more than 10 years and 157 patients were followed up with MRI（follow - up rate was 80. 0% ）, which included 75 males and 82 females. The Leksell Gamma Knife models B was used. The mean age of the patients was 51.4 years（ 10 to 77 years）. GKS was applied as primary treatment for 125 cases （79. 6% ）, and was an adjunctive management approach for 32 cases（20. 4% ）. The mean peripheral dose was 12. 7 Gy（range 8.0 - 14. 4 Gy） and the mean central dose was 28.8 Gy（range 20 - 40 Gy）. The mean volume was 5. 1 cm3 （ range 0. 037 - 27. 300 cm3 ）. The mean follow-up period was6.3 years （1 -15 years）. Results Of this 157 cases, 93 cases（59.2%） showed shrinkage,48 cases （ 30. 6% ） remained stable, 16 cases （ 10. 2% ） showed tumor development, and the overall tumor control rate was 89. 8%. 7 cases died of other causes during the period of follow up and benefit from GKS all their lives. The actuarial 3 - years,5 - years and 10 years tumor control rate were 94% ,92% and 87% respectively. The actuarial 3 - years,5 - years and 10 years hearing preservation rate were 94%, 85% and 64% respectively. The rate of permanent and marked facial paralysis and trigeminal neuropathies was 0. 0%, the rate of transient facial paralysis was 16. 6%, and the incidence of transient trigeminal neuropathies were 17. 8% . Conclusion With a 12 - 14 Gy peripheral prescription dose, GKS was confirmed to have a long term tumor control for small to mediate sized and maintainance of a high quality of life, and could prevent cranial nerve from injury to a great extent- Duaring the long term follow - up period there might be not an end poit due to future reccurrence of VS.

关 键 词：神经鞘瘤 听 伽玛刀治疗 长期随访研究 

分 类 号：R739.4[医药卫生—肿瘤]