伽玛刀Extend系统分次治疗颅内良性病变初步经验
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摘要
目的探讨应用伽玛刀Extend系统分次治疗颅内良性病变的临床效果。方法回顾性分析应用伽玛刀Extend系统治疗13例颅内良性病变的临床资料,其中脑膜瘤7例,垂体瘤5例,海绵窦海绵状血管瘤1例。病变体积1.48～54.26 cm3,平均14.09 cm3。照射方案:10例行2分次治疗,3例行3分次治疗;病变周边剂量16.2～26.2 Gy,平均19.5 Gy;等剂量曲线为45%～50%,平均49.2%。结果随访13例,时间10～24个月,平均18.3个月,MRI检查:病变缩小5例,无明显变化7例,增大1例。12例病变压迫或紧贴视神经、视交叉者,视力提高6例,稳定5例,加重1例。视野缺损改善3例,稳定8例,加重1例。无新发海绵窦神经受损表现。结论 Extend伽玛刀系统分次治疗可用于治疗邻近放射敏感或重要结构的病变以及体积较大、需要重复治疗的病变。
Objective To investigate the therapical effect of multisession gamma knife radiosurgery(GKRS) via Extend system for intracranial benign lesions. Methods Clinical data of 13 patients with intracranial benign lesions were analyzed retrospectively, who received multisession GKRS via Extend system. There were 7 patients with meningiomas, 5 with pituitary adenomas and 1 with cavernous hemangioma in the cavernous sinus. The volume of benign lesions ranged from 1.48 to 54.26 cm3 and the mean volume was14.09 cm3. The radiosurgery scheme was as follows: 2 sessions of radiosurgery were performed in 10 patients and 3 sessions in 3 patients. The peripheral dose of lesions ranged from 16.2 to 26.2 Gy with a mean dose of 19.5 Gy. The isodose line ranged from 45%to 50% with a mean line of 49.2%. Results All the patients were followed up for 10 to 24 months with a mean period of 18.3 months.MRI examination showed that the size of lesions decreased in 5 patients, unchanged in 7 and increased in 1. Of the 12 patients whose lesions oppressed or clinged to optic nerve and optic chiasma, the vision was improved in 6 patients, stable in 5 and deteriorated in 1.There was no newly-developed neurologic deficit of cranial nerves in the cavernous sinus. Conclusions Multisession GKRS via Extend system could be used to treat the lesions adjacent to the structures which is important or of high sensitivity to radiation, or the larger volume lesions needing repeated treatments.
Objective To investigate the therapical effect of multisession gamma knife radiosurgery(GKRS) via Extend system for intracranial benign lesions. Methods Clinical data of 13 patients with intracranial benign lesions were analyzed retrospectively, who received multisession GKRS via Extend system. There were 7 patients with meningiomas, 5 with pituitary adenomas and 1 with cavernous hemangioma in the cavernous sinus. The volume of benign lesions ranged from 1.48 to 54.26 cm3 and the mean volume was14.09 cm3. The radiosurgery scheme was as follows: 2 sessions of radiosurgery were performed in 10 patients and 3 sessions in 3 patients. The peripheral dose of lesions ranged from 16.2 to 26.2 Gy with a mean dose of 19.5 Gy. The isodose line ranged from 45%to 50% with a mean line of 49.2%. Results All the patients were followed up for 10 to 24 months with a mean period of 18.3 months.MRI examination showed that the size of lesions decreased in 5 patients, unchanged in 7 and increased in 1. Of the 12 patients whose lesions oppressed or clinged to optic nerve and optic chiasma, the vision was improved in 6 patients, stable in 5 and deteriorated in 1.There was no newly-developed neurologic deficit of cranial nerves in the cavernous sinus. Conclusions Multisession GKRS via Extend system could be used to treat the lesions adjacent to the structures which is important or of high sensitivity to radiation, or the larger volume lesions needing repeated treatments.
引文
[1] HASELSBERGER K, MAIER T, DOMINIKUS K, et al.Staged gamma knife radiosu rgery for large critically located benign meningiomas:evaluation of a series comprising 20 patients[J]. J Neurol Neurosurg Psychiatry,2009, 80(10):1172-1175.
[2] HIGUCHI Y, SERIZAWA T, NAGANO O, et al. Threestaged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors[J]. Int J Radiat Oncol Biol Phys, 2009, 74(5):1543-1548.
[3] HANSASUTA A, CHOI C Y, GIBBS I C, et al. Multisession stereotactic radiosurgery for vestibular schwannomas:single-institution experience with 383 cases[J]. Neurosurgery, 2011, 69(6):1200-1209.
[4] SAYER F T, SHERMAN J H, YEN C P, et al. Initial experience with the eXtend System:a relocatable frame system for multiple-session gamma knife radiosurgery[J].World Neurosurg, 2011, 75(5-6):665-672.
[5] HASELSBERGER K, MAIER T, DOMINIKUS K, et al.Staged gamma knife radiosurgery for large critically located benign meningiomas:evaluation of a series comprising 20 patients[J]. J Neurol Neurosurg Psychiatry,2009, 80(10):1172-1175.
[6] MAYO C, MARTEL M K, MARKS L B, et al. Radiation dose-volume effects of optic nerves and chiasm[J]. Int J Radiat Oncol Biol Phys, 2010, 76(3 Suppl):S28-S35.
[7] GOH ASC, KIM Y D, WOO K I, et al. Benign orbital apex tumors treated with multisession gamma knife radiosurgery[J]. Ophthalmology, 2013, 120(3):635-641.
[8] KIM B S, IM Y S, WOO K I, et al. Multisession gamma knife radiosurgery for orbital apex tumors[J]. World Neurosurg, 2015, 84(4):1005-1013.
[9] YAMAMOTO M, KIDA Y, FUKUOKA S, et al. Gamma knife radiosurgery for hemangiomas of the cavernous sinus:a seven-institute study in Japan[J]. J Neurosurg,2010, 112(4):772-779.
[10] MA L, CHUANG C, DESCOVICH M, et al. Whole-procedure clinical accuracy of gamma knife treatments of large lesions[J]. Med Phys, 2008, 35(11):5110-5114.
[11] MA L, PETTI P, WANG B, et al. Apparatus dependence of normal brain tissue dose in stereotactic radiosurgery for multiple brain metastases[J]. J Neurosurg, 2011, 114(6):1580-1584.
[12] NGUYEN J H, CHEN C J, LEE C C, et al. Multisession gamma knife radiosurgery:a preliminary experience with a noninvasive, relocatable frame[J]. World Neurosurg, 2014,82(6):1256-1263.
[13] CIFARELLI C P, SCHLESINGER D J, SHEEHAN J P.Cranial nerve dysfunction following gamma knife surgery for pituitary adenomas:long-term incidence and risk factors[J]. J Neurosurg, 2012, 116(6):1304-1310.
[2] HIGUCHI Y, SERIZAWA T, NAGANO O, et al. Threestaged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors[J]. Int J Radiat Oncol Biol Phys, 2009, 74(5):1543-1548.
[3] HANSASUTA A, CHOI C Y, GIBBS I C, et al. Multisession stereotactic radiosurgery for vestibular schwannomas:single-institution experience with 383 cases[J]. Neurosurgery, 2011, 69(6):1200-1209.
[4] SAYER F T, SHERMAN J H, YEN C P, et al. Initial experience with the eXtend System:a relocatable frame system for multiple-session gamma knife radiosurgery[J].World Neurosurg, 2011, 75(5-6):665-672.
[5] HASELSBERGER K, MAIER T, DOMINIKUS K, et al.Staged gamma knife radiosurgery for large critically located benign meningiomas:evaluation of a series comprising 20 patients[J]. J Neurol Neurosurg Psychiatry,2009, 80(10):1172-1175.
[6] MAYO C, MARTEL M K, MARKS L B, et al. Radiation dose-volume effects of optic nerves and chiasm[J]. Int J Radiat Oncol Biol Phys, 2010, 76(3 Suppl):S28-S35.
[7] GOH ASC, KIM Y D, WOO K I, et al. Benign orbital apex tumors treated with multisession gamma knife radiosurgery[J]. Ophthalmology, 2013, 120(3):635-641.
[8] KIM B S, IM Y S, WOO K I, et al. Multisession gamma knife radiosurgery for orbital apex tumors[J]. World Neurosurg, 2015, 84(4):1005-1013.
[9] YAMAMOTO M, KIDA Y, FUKUOKA S, et al. Gamma knife radiosurgery for hemangiomas of the cavernous sinus:a seven-institute study in Japan[J]. J Neurosurg,2010, 112(4):772-779.
[10] MA L, CHUANG C, DESCOVICH M, et al. Whole-procedure clinical accuracy of gamma knife treatments of large lesions[J]. Med Phys, 2008, 35(11):5110-5114.
[11] MA L, PETTI P, WANG B, et al. Apparatus dependence of normal brain tissue dose in stereotactic radiosurgery for multiple brain metastases[J]. J Neurosurg, 2011, 114(6):1580-1584.
[12] NGUYEN J H, CHEN C J, LEE C C, et al. Multisession gamma knife radiosurgery:a preliminary experience with a noninvasive, relocatable frame[J]. World Neurosurg, 2014,82(6):1256-1263.
[13] CIFARELLI C P, SCHLESINGER D J, SHEEHAN J P.Cranial nerve dysfunction following gamma knife surgery for pituitary adenomas:long-term incidence and risk factors[J]. J Neurosurg, 2012, 116(6):1304-1310.