旋转式γ刀在神经外科的临床应用

Clinical application of rotating gamma system radiosurgery in neurosurgery

目的探讨旋转式γ-刀临床应用的安全性和有效性。方法6年来应用旋转式γ-刀治疗颅内病变2381例,其中良性颅内肿瘤1020例,恶性肿瘤796例,脑动静脉畸形374例;脑功能性疾病191例。总结各类疾病旋转式γ-刀的治疗方法,对并发症与不良反应的处理进行探讨。结果对于经过选择的良性病变病例,包括垂体腺瘤、脑膜瘤、前庭神经鞘瘤、脑动静脉畸形、颅咽管瘤等可达到治愈效果;对部分脑转移癌、脑胶质瘤等恶性肿瘤患者可延长生命,提高生存质量。治疗后反应性脑水肿发生率为0.75%。结论旋转式γ-刀是用于治疗脑部疾病的一种高精度、高性能、高疗效的精尖手术设备,可使许多疾病获得较好治疗,但应用不当亦可造成严重并发症,因此一定要严格按规程操作,仔细与严谨设计毁损靶点与准确剂量布局,术后定期随访观察,对出现的并发症及时采取有效措施,以期获取最佳结果。

Objective To explore the safety and efficacy of OUR Rotating Gamma System in neurosurgical clinical application. Methods Between December 1996 and November 2002,2381 patients with intracranial disease were treated by OUR Rotating Gamma. Of 2381 patients, 1020 patients had benign intracranial tumors, 796 with malignant tumor, 374 with cerebral arteriovenous malformations (AVMs) and 191 had functional neurological disorders. The treatment technique of Gamma Knife Stereotactic Radiosurgery, dose prescription and precise onentation performed in intracranial tumor or foci were analyzed and the preliminary outcome of treatment was evaluated in this study. In addition, the management of the possible complication and adverse reaction were studied. Rusults Gamma Knife Stereotactic Radiosurgery alone, or combined with other treatment procedures, can cure some of selected patients with benign brain lesions such as pituitary, meningioma, vestibular schwannomas, AVMs, and craniopharyngioma, etc . And this treatment can also be benefit to some patients with malignant tumors.The rate of radiation edema is 0.75% . Conclusions The results suggest that the Gamma Knife Stereotactic Radiosurgery is a very effective, accurate and relatively safe neurosurgical tool used either as a primary or a adjuvant procedure for treatment of intracranical pathologic processes. However, it might lead some severe or fatal complications when some inappropriate operation was made. Thus, optimal result would not be obtained until the careful and precise Gamma treatment planning based on the operative rules was performed and the effective management for complications during the period of regular follow-up was taken postoperatively.