伽玛刀治疗听神经瘤(附98例分析)

Gamma Knife radiosurgery for acoustic neurinoma:report of 98 cases

目的评价伽玛刀治疗听神经的效果。方法应用OUR旋转式伽玛刀治疗听神经98例。肿瘤直径5.2～29.7mm,平均18.8mm。采用多个放射中心联合照射,周边等剂量曲线为45%～70%,边缘剂量10～13Gy。结果81例获14～84个月随访,平均39个月。MRI示41例(50.6%)肿瘤缩小,38例(46.9%)无变化,2例(2.5%)增大;25例(30.9%)肿瘤中心失增强。无面瘫和面部麻木,听力保留率59.2%。结论伽玛刀对听神经瘤有较高的肿瘤控制率,并能保留有用听力,对面神经、三叉神经损伤小,是小至中等大小听神经瘤可供选择的治疗方法,及术后残余和复发肿瘤的重要辅助治疗手段。

Objective To evaluate the effect of the Gamma Knife radiosurgery on acoustic neuroma. Methods Ninety-eight patients with acoustic neuroma were treated with OUR Rotating Gamma System. The tumor diameter ranged from 5.2 to 29.7 mm with an average of 18.8 mm. Multi-isocenter dose planning placed a marginal dose of 10 to 13 Gy to the 45% to 70% peripheral isodose line. Result Follow-up ranged from 14 to 84 months （mean 39 months） in 81 patients, tumor size reduced in 41 （50.6%）, remained unchanged in 38 （46.9%）, and increased in 2 （2.5%）. A loss of central enhancement was demonstrated on MRI in 25 （30.9%） cases. No patient developed new facial paralysis or facial numbness. The preservation rate of functional heating was 59.2%. Conclusion Gamma Knife radiosurgery achieved high tumor control rate for acoustic neurinoma with preservation of functional heating, minimal facial and trigeminal injury. It provided an optional treatment for patients with small to medium size acoustic neuromas, and an important adjuvant therapy for treating residual and recurrent tumors.