海绵窦海绵状血管瘤的MRI特征与伽玛刀治疗  

Characteristic MR Imaging Features and Gamma Knife Treatment of Cavernous Sinus Cavernous Hemangiomas

作　　者：李杨[1] 王伟[1] 陈兢[1] 李鹏[1] 方芳[1] 张祝均[1] 

机构地区：[1]四川大学华西医院神经外科伽玛刀中心,成都610041

出　　处：《肿瘤预防与治疗》2013年第3期147-150,共4页Journal of Cancer Control And Treatment

摘　　要：目的:探讨海绵窦海绵状血管瘤(CSHAs)的MRI特征和伽玛刀(γ刀)治疗的方法,评价γ刀治疗CSHAs的效果。方法:回顾性分析18例应用γ刀治疗CSHAs的临床资料,其中10例为术后残留,8例为临床影像学诊断。照射肿瘤的周边剂量8.0 Gy^16.0 Gy,平均12.2 Gy±2.6 Gy,等剂量曲线40%~50%,中心剂量16.0Gy^32.0 Gy,平均24.2 Gy±4.6 Gy,随访时间6个月~50个月,平均24.5±18.7个月。结果:MRI显示肿瘤在T1WI呈低信号或等信号,T2WI呈显著高信号,增强后T1WI呈明显均匀强化的高信号,形态特点呈内小外大的哑铃状结构,边缘清晰。γ刀治疗后,5例肿瘤几乎消失,12例肿瘤明显缩小,1例肿瘤无明显变化。所有患者均未出现新的脑神经受损症状,其中两例在γ刀治疗后4个月~8个月出现轻度动眼神经麻痹症状,1例在γ刀治疗后3个月出现轻度外展神经麻痹症状。结论:CSHAs的MRI表现具有特征性。γ刀治疗CSHAs安全可靠,效果良好,无严重并发症。对于中小型(肿瘤最大径<3 cm)或手术后残留的CSHAs,γ刀可作为首选治疗方案。Objective： To investigate the characteristic MRI features of cavernous hemangioma in the cavernous sinus （CSHAs） , and evaluate the effects of Gamma Knife Radiosurgery （GKS）on these lesions. Methods： The clinical data of 18 patients with CSHAs were analyzed retrospectively. Of the 18 patients, 10 had residual tumor after surgery, while 8 were diagnosed by neurora- diology. The mean tumor margin dose was 12. 2Gy ＋2. 6Gy（ranged 8. 0Gy - 16. 0 Gy ）at the isodose line from 40% to 50% ,the mean max dose was 24. 2Gy ＋ 4. 6Gy （ ranged 16. 0Gy - 32. 0 Gy ）. The mean follow-up period was 24. 5months ± 18. 7months （ ranged 6months- 50months）. Results： The MRI showed hypointensity on Tl-weighted images, homogeneous hyperintensity on T2-weighted images. On contrast-enhanced Tl-weighted images, all the tumors were homogeneously and densely enhanced. Configuration features of the lesions were dumbbell-like in shape, with sharp outlines and smaller medial portion and larger lateral compartment. The follow-up MRI images revealed that of the 18 tumors ,5 almost disappeared, 12 decreased markedly in size, only one tumor kept stable. No patients suffered from a new cranial never damnification after GKS treatment. Two patients suffered from mild oculomotor palsy between 4 months to 8 months. One patient suffered from mild abducens palsy after 3 months. Conclusion： CSHAs has characteristic MRI ap- pearance. GKS for CSHAs is safe and effective without serious complications. For postoperative tumor residual, small and middle-sized CSHAs, GKS could be the first choice of treatment.

关 键 词：海绵窦 海绵状血管瘤 磁共振成像 伽玛刀 

分 类 号：R743[医药卫生—神经病学与精神病学]