伽玛刀治疗后脑水肿的临床特征和影响因素

Clinical characteristics and influential factors for brain edema after gamma knife radiosurgery

目的探讨伽玛刀治疗后脑水肿发生的临床特征和影响因素。方法回顾有随访资料经伽玛刀治疗患者365例。通过描述性研究,先确定伽玛刀治疗后脑水肿一些临床特征。然后采用χ2检验和Logistic回归分析从以下变量中确定脑水肿发生的影响因素:年龄、性别、KPS、靶周水肿情况、90%靶病灶容积的边缘剂量、靶病灶部位、靶病灶的平均直径、靶病灶与正常脑组织的关系。结果伽玛刀治疗后1年内脑水肿总的发生率为22.2%,以胶质瘤、动静脉畸形、海绵状血管瘤和脑膜瘤较为多见,多在治疗后2～4个月发生,近半数有症状。有症状者大多使用20%甘露醇加糖皮质激素比单纯使用甘露醇有更好的治疗反应。与脑水肿发生显著相关的因素为病变部位、病灶平均直径和病灶与正常脑组织的关系。结论脑水肿是伽玛刀治疗后的重要并发症,有其特有的规律,病灶本身的特点是其发生的关键。

Objective To explore some clinical characteristics and influential factors for brain edema after gamma knife radiosurgery. Methods A total of 365 patients with follow-up treated by gamma knife radiosurgery were reviewed. Some clinical characteristics of brain edema after gamma knife radiosurgery were determined by descriptive statistical method. The influential factors were determined by X^2 test and logistic regression model from the following variables： age, gender, KPS, edema condition around the target, marginal radiative dosage at isocurve surrounding 90% target volume, target location, mean maximal diameter of target and relationship between target and brain tissue. Results Brain edema was observed in 81 patients （22.2%） with a more common frequency in the patients of glioma, arteriovenous malformation, cavernous malformation and meningoma. Of the brain edema, the most occurred in 2 -4 month after operation and about half patients showed the clinical symptom. The combined therapy of mannitol and glucocorticosteroid was better than mannitol only. x^2 test and logistic regression model showed target location, mean maximal diameter of target and relationship between target and brain tissue were significant influential factors for brain edema. Conclusion Brain edema is an important complication after gamma knife radiosurgery with its specific characteristics. The characteristics of target focus play an important role in the occurrence of brain edema.