神经内镜后放疗治疗囊性颅咽管瘤的长期疗效研究  

Long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas

作　　者：王志辉 耿晓坤[2] Wang Zhihui;Geng Xiaokun(Changsha Health Vocational College,Changsha 410100,China;Department of Neurology,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China)

机构地区：[1]长沙卫生职业学院,410100 [2]首都医科大学附属北京潞河医院神经内科,101149

出　　处：《中国医师杂志》2019年第12期1778-1782,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(81501141);北京市教委科技计划项目(KM201610025028)~~

摘　　要：目的探讨神经内镜后放疗治疗囊性颅咽管瘤的长期疗效。方法9例囊性颅咽管瘤患者神经内镜下囊肿穿刺术和开窗术后接受分次立体定向放射治疗(FSRT)。神经内镜手术重点在于囊肿开窗术拓展和囊肿部分外部冲洗。FRST准直器2.5~3.0cm,靶体积1.1~43.8 cm^3,分次剂量1.8 Gy,总剂量50.4 Gy。结果9例患者的中位随访时间为72.9个月。9例患者当中,8例患者实现了肿瘤控制。肿瘤体积缩减发生在神经内镜手术后1、6个月、1年和2年。仅有1例患者出现囊肿复发,并在手术后1年接受二次治疗。患者头痛和视力下降等临床症状在神经内镜手术后快速缓解。随访期内未出现新的视力障碍、内分泌病或下丘脑功能紊乱。结论神经内镜开窗术后立体定向放射治疗囊性颅咽管瘤能够实现较长一段时间内对肿瘤的有效控制,改善临床症状,且不会出现内分泌病变。Objective To explore the long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas.Methods Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration,followed by fractionated stereotactic radiotherapy(FSRT).The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents.The collimator of FSRT ranged from 2.5 cm to 3.0 cm,and the target volume 1.1-43.8 cm^3,dose per fraction 1.8 Gy,total dose 50.4 Gy.Results The median follow-up period was 72.9 months.Tumor control was achieved in 8 of 9 patients.Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone at 6 months,1 year,and 2 years.One recurrent case showed multilobulated cysts,and a second surgery was required 1 year after the treatment.Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure.No new visual disturbances,endocrinopathy,or hypothalamic dysfunction was observed during follow up.Conclusions Stereotactic radiotherapy for cystic craniopharyngioma after endoscopic fenestration can effectively control the tumor for a long period of time,improve the clinical symptoms and avoid endocrine diseases.

关 键 词：颅咽管瘤 神经内窥镜检查 立体定位技术 放射疗法 

分 类 号：R73[医药卫生—肿瘤]