立体定向放射外科治疗脑膜瘤的研究  

Stereotactic radiosurgery in treatment of intracranial meningiomas

作　　者：黄礼明[1] 朱飚[1] 卢刚[1] 厉民 赵仲生 王坚 

机构地区：[1]浙江省人民医院神经外科,杭州310014 [2]立体定向放射外科治疗中心 [3]病理科

出　　处：《浙江医学》2012年第5期317-319,共3页Zhejiang Medical Journal

摘　　要：目的研究立体定向放射外科治疗脑膜瘤的疗效、作用机制及其治疗策略。方法对428例接受立体定向放射外科治疗的脑膜瘤患者进行详尽的影像学随访和组织学研究，以了解和分析其疗效。结果428例脑膜瘤中，影像学诊断167例，组织病理学检查确诊261例。肿瘤部位：大脑凸面82例，颅底211例，脑室内23例，其它部位112例。立体定向放射外科治疗平均周边剂量12．5Gy，平均中心剂量263Gy，剂量曲线40％-50％。随访2年以上，影像学检查评估疗效：病灶明显缩小57例（13．3％），病情稳定297例（69．4％），病灶增大6例（1．4％），其中43例行血管造影检查，37例肿瘤血管染色明显减少。59例脑膜瘤行立体定向放射外科治疗后接受手术治疗，组织学检查发现脑膜瘤主要病理改变为肿瘤细胞的增殖指数降低、血栓形成、小血管闭塞和肿瘤问质增生。治疗后68例（15．9％）出现顽固性瘤周脑水肿、放射性脑病等严重并发症。结论立体定向放射外科治疗可能通过其抑制脑膜瘤细胞增殖、减少和阻断肿瘤血液供应的放射生物学效应对多数脑膜瘤产生延缓肿瘤生长、减少手术治疗中出血以及推迟术后复发时间的治疗作用。对于无法或不适合手术治疗以及复发性脑膜瘤，立体定向放射外科治疗是一种有效的微创治疗手段。Objective To investigate the efficacy of stereotactic radiosurgery in treatment of intracranial meningiomas and its strategies. Methods Total 428 patients with intracranial meningiomas were enrolled in the study. Among them 167 cases were diagnosed by clinical images and another 261 were confirmed by histology; 82 tumors were located on the protruding surface, 211 on the base skull, 23 were intraventricular meningiomas and 112 in other Iocatins. All patients were treated with stereotactic radiosurgery; a median margin dose of 13.5 Gy and a median central dose of 26.3 Gy were delivered with dose-curve of 40 -50%. The therapeutic effects were evaluated by imaging and histological investigation 2y after radiosurgery. Results Among 428 cases, tumors were reduced in 57 （13.3%）, no change in 297 （69.4%） and progress in 6 （1.4%）. Sixty eight （15.9%） patients had serious complications with refractory peritumoral vasogenic brain edema and radiated-encephalon. Forty three cases underwent angiography examinations and the diluted tumorous vascular stain was observed in 37. Fifty nine patients received surgery after stereotactic radiosurgery, and main histological demonstrated the decreased proliferating-index of tumor cells; thrombosis, embolism and interstitial hyperplasia. Conclusions Stereotactic radiosurgery can inhibit tumor cell proliferation, reduce blood-supplying of tumor and might be used as additional minimally invasive management option for intracranial meningiomas in patients who either fail or are unsuitable for resection.

关 键 词：脑膜瘤立体定向 放射外科放射生物学效应 疗效 

分 类 号：R742[医药卫生—神经病学与精神病学]