伽玛刀分次治疗海绵窦巨大海绵状血管瘤的效果
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摘要
目的探讨伽玛刀分次治疗海绵窦巨大海绵状血管瘤的临床效果。方法对39例海绵窦巨大海绵状血管瘤患者在局部麻醉下安装立体定位头架并定位,然后采用伽玛刀在20个月内分次治疗,即1～5个月行第1次伽玛刀治疗,病灶中心剂量为18～26 Gy,边缘剂量为9～13 Gy; 6～12个月行第2次伽玛刀治疗,根据病灶缩小程度及大小不同,病灶中心剂量为26 Gy或30 Gy,边缘剂量为13 Gy或15 Gy; 12个月后根据病灶缩小程度及仍有明显病灶者行第3次伽玛刀治疗,病灶中心剂量为30 Gy,边缘剂量为15 Gy。结果随访6～48个月,平均36个月,39例患者均未出现临床症状加重及新的脑神经受损症状。39例患者第1次治疗后6～8个月行MRI检查示病灶均有不同程度缩小,病灶缩小>30%。第2次伽玛刀治疗后12个月行MRI检查示18例患者病灶基本消失,病灶缩小>90%;21例患者病灶缩小,病灶缩小>50%。21例第3次伽玛刀治疗后12个月行MRI检查示病灶缩小,病灶缩小>90%。5例由于不能耐受或其他原因拒绝第3次伽玛刀治疗的患者,治疗后24个月行MRI检查示病灶较第2次伽玛刀治疗后12个月进一步缩小,病灶缩小>80%。39例患者均未出现临床症状加重及新的脑神经受损症状,症状改善率为87.2%。结论伽玛刀分次治疗海绵窦巨大海绵状血管瘤疗效显著,并可有效改善患者的临床症状。
Objective To investigate the clinical efficacy of gamma knife in the fractional treatment of giant cavernous hemangioma of cavernous sinus.Methods The stereotactic head frame was installed and positioned in 39 patients with giant cavernous hemangioma of cavernous sinus under local anesthesia.Then,patients were fractional treated with gamma knife in 20 months.The first treatment was performed in1-5 months with focal central dose of 18-26 Gy and marginal dose of 9-13 Gy.The second treatment was carried out in 6-12 months with focal central dose of 26 or 30 Gy and marginal dose of 13 or 15 Gy.In patients who had obvious lesions after 12 months,the third treatment was conducted with focal central dose of 30 Gy and marginal dose of 15 Gy.Results After 6～48 months of follow-up(average,36 months),no patients had symptom exacerbation and new brain nerve damage.MRI showed that lesions reduced by>30% in all the 39 patients after the first treatment.After the second treatment,that lesions reduced by>90% in 18 patients,and by>50% in 21 patients.The third gamma knife treatment in MRI examination showed that the lesions were reduced and the lesions were reduced by>90% in 21 patients.Five patients refused the third treatment due to intolerance or other reasons.After 24 months of treatment,MRI showed that the lesions decreased by>80%.The no clinical symptoms aggravated and new symptoms of cranial nervedamage in 39 patients,the symptom improvement rate was 87.2%.Conclusion Gamma knife fractional treatment can effectively improve clinical symptoms in patients with giant cavernous hemangioma of cavernous sinus.
Objective To investigate the clinical efficacy of gamma knife in the fractional treatment of giant cavernous hemangioma of cavernous sinus.Methods The stereotactic head frame was installed and positioned in 39 patients with giant cavernous hemangioma of cavernous sinus under local anesthesia.Then,patients were fractional treated with gamma knife in 20 months.The first treatment was performed in1-5 months with focal central dose of 18-26 Gy and marginal dose of 9-13 Gy.The second treatment was carried out in 6-12 months with focal central dose of 26 or 30 Gy and marginal dose of 13 or 15 Gy.In patients who had obvious lesions after 12 months,the third treatment was conducted with focal central dose of 30 Gy and marginal dose of 15 Gy.Results After 6～48 months of follow-up(average,36 months),no patients had symptom exacerbation and new brain nerve damage.MRI showed that lesions reduced by>30% in all the 39 patients after the first treatment.After the second treatment,that lesions reduced by>90% in 18 patients,and by>50% in 21 patients.The third gamma knife treatment in MRI examination showed that the lesions were reduced and the lesions were reduced by>90% in 21 patients.Five patients refused the third treatment due to intolerance or other reasons.After 24 months of treatment,MRI showed that the lesions decreased by>80%.The no clinical symptoms aggravated and new symptoms of cranial nervedamage in 39 patients,the symptom improvement rate was 87.2%.Conclusion Gamma knife fractional treatment can effectively improve clinical symptoms in patients with giant cavernous hemangioma of cavernous sinus.
引文
[1]冯富强,冀培刚,张江红,等.伽玛刀治疗海绵窦海绵状血管瘤的疗效分析:附19例报道[J].中国临床神经外科杂志,2018,23(2):72-74.
[2]Wang Y,Li P,Zhang X J,et al.Gamma knife surgery for cavernous sinus hemanginoma:a report of 32 cases[J].World Neurosurg,2016,94:18-25.
[3]González Darder J M,Vera Román J M,Pesudo Martínez J V,et al.Tumoral presentation of primary central nervous system lymphomatoid granulomatosis[J].Acta Neurochir(Wien),2011,153(10):1963-1970.
[4]何占彪,王宏伟.脑内海绵状血管瘤的影像学诊断特点及治疗选择[J].中华神经外科疾病研究杂志,2016,15(4):378-380.
[5]邓珍萍,梁娜,黄润生,等.MRI对伽玛刀治疗海绵窦海绵状血管瘤的疗效评估[J].西南国防医药,2015,25(2):144-147.
[6]Bansal S,Suri A,Singh M,et al.Cavernous sinus hemangioma:a fourteen year single institution experience[J].J Clin Neurosci,2014,21(6):968-974.
[7]钟兵,黄理金,刘承勇,等.海绵窦海绵状血管瘤立体定向放射治疗疗效的系统评价[J].中国神经精神疾病杂志,2014,40(1):43-47.
[8]Fraser J F,Mass A Y,Brown S,et al.Transnasal endoscopic resection of a cavernous sinus hemangioma:technical note and review of the literature[J].Skull Base,2008,18(5):309-315.
[9]Iwai Y,Yamanaka K,Nakajima H,et al.Stereotactic radiosurgery for cavernous sinus cavernous hemangioma--case report[J].Neurol Med Chir(Tokyo),1999,39(4):288-290.
[10]王雅迪,何占彪,王宏伟,等.伽玛刀治疗海绵窦海绵状血管瘤:附六例报告[J].中华神经外科杂志,2017,33(4):358-360.
[11]任海波,王毅,李鹏,等.伽马刀治疗海绵窦海绵状血管瘤的效果分析[J].中国脑血管病杂志,2018,15(6):304-308.
[12]黄敏仪,邓印辉,梁舜尧.海绵窦海绵状血管瘤伽玛刀分次治疗的效果分析[J].中国微侵袭神经外科杂志,2018,23(3):104-106.
[13]李杨,王伟,陈兢,等.海绵窦海绵状血管瘤的MRI特征与伽玛刀治疗[J].肿瘤预防与治疗,2013,26(3):147-150.
[2]Wang Y,Li P,Zhang X J,et al.Gamma knife surgery for cavernous sinus hemanginoma:a report of 32 cases[J].World Neurosurg,2016,94:18-25.
[3]González Darder J M,Vera Román J M,Pesudo Martínez J V,et al.Tumoral presentation of primary central nervous system lymphomatoid granulomatosis[J].Acta Neurochir(Wien),2011,153(10):1963-1970.
[4]何占彪,王宏伟.脑内海绵状血管瘤的影像学诊断特点及治疗选择[J].中华神经外科疾病研究杂志,2016,15(4):378-380.
[5]邓珍萍,梁娜,黄润生,等.MRI对伽玛刀治疗海绵窦海绵状血管瘤的疗效评估[J].西南国防医药,2015,25(2):144-147.
[6]Bansal S,Suri A,Singh M,et al.Cavernous sinus hemangioma:a fourteen year single institution experience[J].J Clin Neurosci,2014,21(6):968-974.
[7]钟兵,黄理金,刘承勇,等.海绵窦海绵状血管瘤立体定向放射治疗疗效的系统评价[J].中国神经精神疾病杂志,2014,40(1):43-47.
[8]Fraser J F,Mass A Y,Brown S,et al.Transnasal endoscopic resection of a cavernous sinus hemangioma:technical note and review of the literature[J].Skull Base,2008,18(5):309-315.
[9]Iwai Y,Yamanaka K,Nakajima H,et al.Stereotactic radiosurgery for cavernous sinus cavernous hemangioma--case report[J].Neurol Med Chir(Tokyo),1999,39(4):288-290.
[10]王雅迪,何占彪,王宏伟,等.伽玛刀治疗海绵窦海绵状血管瘤:附六例报告[J].中华神经外科杂志,2017,33(4):358-360.
[11]任海波,王毅,李鹏,等.伽马刀治疗海绵窦海绵状血管瘤的效果分析[J].中国脑血管病杂志,2018,15(6):304-308.
[12]黄敏仪,邓印辉,梁舜尧.海绵窦海绵状血管瘤伽玛刀分次治疗的效果分析[J].中国微侵袭神经外科杂志,2018,23(3):104-106.
[13]李杨,王伟,陈兢,等.海绵窦海绵状血管瘤的MRI特征与伽玛刀治疗[J].肿瘤预防与治疗,2013,26(3):147-150.