海绵窦海绵状血管瘤伽玛刀治疗随访观察  

Follow-up observation of gamma knife radiosurgery for cavernous sinus cavernous hemangioma

作　　者：王建峰[1] 刘花利 孟喜君[1] 李文涛[1] 任春营 夏明[1] 淡咏[1] Wang Jianfeng;Liu Huali;Meng Xijun;Li Wentao;Ren Chunying;Xia Ming;Dan Yong(Center of Gamma Knife,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shannxi 710061,China;Department of Emergency,the Rehabilitation Hospital in Shannxi Province,Xi'an,Shannxi 710065,China)

机构地区：[1]西安交通大学第一附属医院伽玛刀中心,陕西西安710061 [2]陕西省康复医院急诊科,陕西西安710065

出　　处：《中国微侵袭神经外科杂志》2025年第2期78-82,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的为探讨伽玛刀治疗海绵窦海绵状血管瘤(cavernous sinus cavernous hemangioma,CSH)的安全性与有效性。方法回顾性分析26例CSH患者的临床资料。男5例(19%),女21例(81%),平均年龄53岁(35~78岁),经手术证实12例,伽玛刀治疗前经影像证实14例;均采用Perfexion伽玛刀治疗。伽玛刀治疗前有脑神经症状16例(61%),12例症状主要为头痛、头晕,2例无明显症状。伽玛刀治疗前体积为2.02~106.3cm^(3)(平均19.36cm^(3)),边缘剂量为6~15Gy(平均12.9Gy)。4例病变较大,采用分次治疗。22例患者分为手术组10例和非手术组12例;边缘低剂量组7例(6~12Gy)和高剂量组15例(13~15Gy),运用单变量多因素方差分析CSH控制率。结果随访时间3~73个月(平均18.2个月),有效率100%;其中显著疗效25例(96%),显效1例,(4%)。1例病变在左侧的患者出现右眼视力下降,1例癫痫。伽玛刀治疗后,脑神经症状均得到不同程度缓解。CSH在术后3~12个月迅速缩小,并在24~36个月内随着时间变化,肿瘤控制率增高;但随着随访时间继续延长,肿瘤控制率无明显提高。伽玛刀治疗前手术及边缘高剂量并不能提高肿瘤控制率。结论伽玛刀治疗CSH有效安全,并可作为代替临床开颅手术的一种微创方法。Objective To evaluate the safety and efficacy of Gamma Knife radiosurgery(GKS)in the treatment of cavernous sinus cavernous hemangioma(CSH).Methods The clinical data of 26 patients with CSH were analyzed retrospectively.There were 5 males(19%),21 females(81%),with an average age of 53 years(35-78 years),12 cases confirmed by surgery,and 14 confirmed by imaging before GKS.All the patients were treated with the Perfexion Gamma Knife.Before GKS,16(61%)had cranial nerve symptoms,12 had headache and dizziness,and 2 had no obvious symptoms.The volume of CSH before GKS was 2.02-106.3 cm^(3)(average 19.36cm^(3)),and the marginal dose was 6-15Gy(average 12.9Gy).Four patients with larger lesions underwent fractionated treatment.The 22 patients were divided into the operation group(n=10)and the non-operation group(n=12).There were 7 cases(6-12Gy)in the marginal low-dose group and 15 cases(13-15Gy)in the high-dose group,and univariate multivariate ANOVA was used to assess the CSH control rate.Results The follow-up period ranged from 3 to 73 months(average 18.2 months),and the response rate was 100%,includingn significant efficacy in 25 patients(96%)and certain efficacy in 1(4%).One patient with lesions on the left side had decreased vision in the right eye and one had epilepsy.After GKS,the cranial nerve symptoms were alleviated to varying degrees.CSH shuttered rapidly at 3-12 months after GKS,and increased the tumor control rate with time change in 24-36 months,but with the extension of follow-up time,the tumor control rate did not improve significantly.Neither prior surgery nor higher marginal doses significantly improved tumor control rates.Conclusions GKS is effective and safe in the treatment of CSH,and can be used as a minimally invasive alternative to clinical craniotomy.

关 键 词：血管瘤 海绵状 中枢神经系统 伽玛刀 随访 

分 类 号：R739.41[医药卫生—肿瘤]