胶质瘤X-刀治疗后放射性坏死貌似肿瘤复发

The Radiation Necrosis Seemingly Like Recurrent Brain Tumor After Stereotactic Radiotheraph of Glioma

目的 探讨X -刀治疗胶质瘤后放射性坏死貌似肿瘤复发的临床表现与影像学特点。方法 回顾性分析7例因胶质瘤而首选X- 刀治疗后疑似肿瘤复发再行手术治疗,病理结果证实为放射性坏死病人的临床表现与影像学特点。结果 7例病人均在X -刀治疗后半年内,平均4 .3个月,出现颅内压增高症状或原有症状的加重,影像学(CT、MRI)特征表现为病灶范围扩大,病灶无明显增强及占位表现;手术切除病灶后病理报告为坏死组织,未发现肿瘤细胞。结论 X -刀治疗半年内出现的颅内压(ICP)增高症状或原有症状加重可能为延迟性放射性坏死,极易与胶质瘤复发混淆,应根据影像学特点加以鉴别,鉴别困难时,应先行保守治疗,无效时方可手术治疗,以减少病人不必要的神经损害和经济负担。

Objective To analyse the characteristic of clinic and imaging(CT and MRI)which seeming like recurrent brain tumor after stereotactic radiotherapy of glioma.Methods In this study,it is retrospectively analyzed that the clinical and radiology features in 7 patients who were treated firstly by X-knife and then operation was underwent because of doubting tumor recurrent,but the results from pathology confirmed that in fact it was a necrosis.Results All patients presented in symptoms and signs of increasing ICP within half of year(mean 4.3 months)after radiation treatment.The radiology features mainly showed the range of primary focus was enlarged without marked enhancement and mass effective.Conclusion The clinical symptoms and signs presented during half of year after stereotactic radiotherapy of glioma is most likely a radiation necrosis and the distinguishing would be made on results of clinic and radiology.When there is some confusion,firstly a conservative treatment would be done.However,operation can be undergone if the treatment is not effective.