伽玛刀治疗三叉神经鞘瘤疗效观察  

Gamma knife radiosurgery for trigeminal schwannomas

作　　者：杜汉强[1] 梁军潮[1] 张聿浩[1] 刘德平[1] 伍犹梁[1] 周慧[1] 周丽兰[1] 成红梅[1] 

机构地区：[1]广州军区广州总医院神经外科,510010

出　　处：《中华神经外科杂志》2011年第10期992-995,共4页Chinese Journal of Neurosurgery

摘　　要：目的回顾性分析评价伽玛刀对三叉神经鞘瘤的临床疗效。方法分析2004年2月至2010年5月于本中心应用Leksell“C”型伽玛刀治疗三叉神经鞘瘤41例，其中13例为术后复发或残留，28例经MRI诊断首选伽玛刀治疗。肿瘤平均直径22mm，肿瘤的平均体积9cm3。照射肿瘤的平均中心剂量为29．2Gy，平均周边剂量12．8Gy。结果平均随访时问38个月。症状变化：首选伽玛刀治疗的患者8例症状完全消失；18例好转，11例症状无变化或轻微加重，4例因肿瘤增大症状加重。肿瘤变化：7例肿瘤基本消失，22例肿瘤缩小，8例肿瘤未增大，4例体积增大，肿瘤控制率90．2％。结论伽玛刀对中小型三叉神经鞘瘤治疗安全有效，有良好的中长期控制作用，并可有效地改善其临床症状，保护周围脑神经，肿瘤控制剂量为12～13Gy。Objective To evaluate the role of gamma knife （GK） in the treatment of trigeminal sehwannomas. Methods From Feb 2004 to May 2010 , 41 patients with trigeminal schwannoma treated with GK radiosurgery were reviewed. GK was the primary treatment modality in 28 cases and followed microsurgery in 13 cases. Of the 41 tumors, 15 had small cysts within the tumors, the rest were solid. The mean diameter of the 41 tumors was 22 mm （ range ： 10 - 43 mm） and the tumors ranged in volume from 1 to 37 cm3（ with a mean volume of 9 cm3） . The maximum dose irradiated to tumor was 20 to 38 Gy （mean ： 29.2 Gy） , the tumor margin dose ranged from 10 to 15 Gy （mean ： 12. 8 Gy）. Results 41 patients had been followed for 12 to 73 months （mean ： 38 months）. Mild numbness or diplopia relieved completely in 8 patients after GK treatment. Improvement of neurological deficits was seen in 18, unchanged dysfunction or slightly worsening of trigeminal nerve deficits in 11. Four patients had mild worsened symptoms at different time because of tumor progression. Tumor growth control ： tumor disappeared after GK treatment was observed in 7 cases from 20 to 48 months after a marked decrease in volume was observed in 22 cases , unchange in 8 cases and increase in 3 cases. The control rate of the 35 tumors was 90. 2 % （ 37/ 41 ）. Conclusion Small and middle - size trigeminal schwannomas are the best candidates for GK radiosurgery, stereotaetic radiosurgery is an effective and minimally invasive management option in patients with residual or newly diagnosed trigeminal schwannomas.

关 键 词：三叉神经鞘瘤 伽玛刀治疗 

分 类 号：R739.41[医药卫生—肿瘤]