剂量分割分阶段伽玛刀治疗紧邻视路的海绵窦海绵状血管瘤单中心回顾性研究  

Dose-staged gamma knife radiosurgery for perioptic cavernous sinus hemangiomas:A single-center retrospective study

作　　者：张茜 魏立晨 丁建 戴嘉中 陈晶晶 汤旭群 吴瀚峰 潘力 ZHANG Xi;WEI Lichen;DING Jian;DAI Jiazhong;CHEN Jingjing;TANG Xuqun;WU Hanfeng;PAN Li(Department of Neurosurgery,Shanghai Gamma Hospital,Shanghai 200235,China;Department of Radiology,Shanghai Gamma Hospital,Shanghai 200235,China)

机构地区：[1]上海伽玛医院神经外科,上海200235 [2]上海伽玛医院放射科,上海200235

出　　处：《国际神经病学神经外科学杂志》2024年第3期70-75,共6页Journal of International Neurology and Neurosurgery

基　　金：中华国际医学交流基金会肿瘤精准放疗星火计划(2019-N-11-38)。

摘　　要：目的分析伽玛刀剂量分割分阶段策略治疗紧邻视路结构海绵窦海绵状血管瘤的疗效和安全性。方法分析2018年3月—2020年9月上海伽玛医院采用分阶段伽玛刀治疗紧邻视路海绵窦海绵状血管瘤11例患者的临床资料,10例为磁共振影像学诊断,1例为经鼻蝶手术后有明确的组织病理学诊断;10例女性患者,年龄27~72岁,中位年龄40岁;肿瘤体积5.54~31.00 cm^(3),中位体积15.09 cm^(3);11例患者均完成两阶段伽玛刀治疗,2次伽玛刀间隔时间3~9个月(中位8个月);第一阶段伽玛刀处方周边剂量8~10 Gy(中位8.8 Gy),等剂量线40%~50%(中位45%);第二阶段处方周边剂量8~10 Gy(中位8.8 Gy),等剂量线40%~52%(中位46%)。结果伽玛刀治疗后随访时间25~60个月(中位40个月);第二阶段伽玛刀治疗时肿瘤体积较第一阶段缩小20.3%~85.3%(中位64.2%);随访终点所有11例患者的肿瘤均得到控制(控制率100%),分阶段伽玛刀治疗后肿瘤体积较治疗前缩小70.6%~92.5%(中位83.0%);90.9%的患者(n=10)在伽玛刀治疗后临床症状消失或改善,随访中无辐射诱导的视路损伤或其他神经功能障碍的发生。结论剂量分割分阶段伽玛刀是紧邻视路结构的海绵窦海绵状血管瘤有效安全合理的治疗策略。Objective To investigate the efficacy and safety of gamma knife radiosurgery(GKRS)in the treatment of perioptic cavernous sinus hemangiomas(CaSHs).Methods An analysis was performed for the clinical data of 11 patients who received GKRS for the treatment of perioptic CaSHs in Shanghai Gamma Hospital from March 2018 to September 2020,among whom 10 patients were diagnosed based on magnetic resonance imaging and 1 patient was diagnosed based on histopathology after endonasal transsphenoidal surgery.There were 10 female patients with a median age of 40(range 27-72)years.Tumor volume ranged from 5.54 cm^(3) to 31.00 cm^(3),with a median tumor volume of 15.09 cm^(3).All 11 patients underwent two-dose-staged GKRS,with a median interval of 8 months(range 3-9 months)between the two stages of GKRS.In the first stage of GKRS,the peripheral dose of gamma knife was 8-10 Gy(median 8.8 Gy),with an isodose contour of 40%-50%(median 45%);in the second stage of GKRS,the peripheral dose of gamma knife was 8-10 Gy(median 8.8 Gy),with an isodose contour of 40%-52%(median 46%).Results The patients were followed up for 25-60 months(median 40 months)after GKRS.Tumor volume was reduced by 20.3%-85.3%(median 64.2%)from the first stage to the second stage of GKRS.At the end of follow-up,all 11 patients achieved tumor control,with a control rate of 100%,and tumor volume was reduced by 70.6%-92.5%(median 83.0%)after GKRS.Of all 11 patients,10(90.9%)had disappearance or improvement of their clinical symptoms after GKRS,and no radiation-induced optic neuropathy or neurological dysfunction was observed during follow-up.Conclusions Dose-staged GKRS is an effective,safe,and reasonable treatment strategy for perioptic CaSHs.

关 键 词：海绵窦海绵状血管瘤 剂量分割分阶段 立体定向放射外科 伽玛刀 

分 类 号：R743[医药卫生—神经病学与精神病学]