伽玛刀治疗颅内脑外型海绵状血管瘤的临床分析  

Gamma knife in treatment of extracerebral cavernous hemangiomas

作　　者：耿明英[1] 张子义 程远[3] 许民辉[1] 沈光建[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所神经外科,重庆400042 [2]山东省聊城市东阿县人民医院影像科,山东聊城252201 [3]重庆医科大学附属第二医院神经外科,重庆400016

出　　处：《第三军医大学学报》2012年第13期1344-1346,共3页Journal of Third Military Medical University

摘　　要：目的探讨伽玛刀治疗颅内脑外型海绵状血管瘤的临床疗效,并总结伽玛刀治疗经验。方法收集2002年5月至2009年5月位于海绵窦旁颅内脑外海绵状血管瘤6例,采用直接伽玛刀治疗4例,开颅手术切除后伽玛刀治疗2例,平均有效照射剂量为12.9(11～16)Gy,视神经接受剂量均小于9.0 Gy(2.4～9.0 Gy)。全部病例随访6个月至9年。结果治疗后5例症状改善,1例仍有复视。MRI显示病灶消失1例,缩小4例,无变化1例。结论对病灶难以手术或难以耐受手术的颅内脑外型海绵状血管瘤,伽玛刀治疗是一种安全有效的治疗方法。Objective Intracranial extracerebral cavernous hemangiomas （ECAH） may develop in the cavernous sinus. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We discussed our experience in treating intracranial extracerebral cavernous hemangiomas by gamma knife radiosurgery （GKS） and share experience for gamma knife usage. Methods A total of 6 symptomatic patients with ECAH who undergoing GKS between May 2002 to May 2009 were collected in this study. The hemangiomas were located in the cavernous sinus. The average volume of ECAH was 4.3 cm^3 （ range from 3.8 to 6. 8 cm^3）. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity （6 patients ）. There were 4 patients treated by GKS based on clinical and imaging criteria, and the left 2 patients receiving microsurgical partial excision biopsy first and then cured by GKS. The average of irradiation dose delivered to the margin was 12.9 Gy （ranging from 11 to 16 Gy）. The close to the optic nerve in all patients was less than 9 Gy （ range 2.4 to 9 Gy）. All patients were followed up for 6 months to 9 years. Results Five patients had symptom improvement, and one patient had persistent diplopia. Follow-up MRI image displayed that tumor disappeared in 1 patient, decreased in size in 4 patients, and had no change in 1 patient. Conclusion GKS is an effective and safe method to treat ECAH for the patients whose tumor are difficult to use surgical treatment or difficult to tolerance for surgery.

关 键 词：脑外型海绵状血管瘤 伽玛刀治疗 手术切除 

分 类 号：R651.12[医药卫生—外科学] R732.2[医药卫生—临床医学]