伽玛刀治疗颅底良性脑膜瘤临床研究

Gamma knife radiosurgery in the management of benign skull base meningiomas

目的探讨伽玛刀放射外科治疗良性颅底脑膜瘤中长期疗效和不良反应。方法选取了1998-2003年治疗的获得完全随访资料的颅底脑膜瘤患者166例,全组患者肿瘤体积0.42- 43.4cm3,平均(7.2±3.9)cm3,给予周边剂量平均(12.4±2.6)Gy,中心剂量平均(27.9±5.9)Gy,其中12例患者采用肿瘤体积分割二阶段治疗。对治疗前后的影像学改变、KPS评分和神经功能缺损评估。结果平均随访期为(55.4±18.2)个月(36-96个月)。总体控制率为95.2%(158/166);KPS评分得到显著提高,神经症状总体满意率为94.5%(157/166),主要副作用是放射性脑水肿11例(6.6%),有5例(3%)患者出现新的神经缺损。结论伽玛刀放射外科可以作为有手术禁忌或拒绝手术治疗体积较小脑膜瘤患者的首选性治疗,也可以作为颅底较大脑膜瘤开颅术后的辅助性治疗,能够较长期控制肿瘤复发,提高或保持患者的生存质量。

Objective To evaluate the middle to long term outcome of clinical efficacy and toxicity of gamma knife radiosurgery for skull base meningiomas. Methods From 1998 to 2003, a total of 183 patients received gamma knife radiosurgery for skull base meningiomas and clinical material of 166 cases were collected. Tumour volumes ranged from 0.42cm^3 - 43.4cm^3 （ mean 7.2 ± 3.9cm^3 ） with a mean dose of （12.4 ± 2.6）Gy were given to the tumour border at prescribed isodose curves （range 40% -80% ）. 12 patients received two-staged gamma knife radiosurgery. Radiological changes, KPS score and neurosurgical improvement were evaluated. Results The overall tumour growth control rate is 95.2% （158/166） and neurological improvement rate is 94.5% （157/166） and KPS score were improved significantly. The main complications is radiation induced brain edema （ 11 case, 6.6% ） and five cases （ 3% ） new neurological deficits. Conclusion Gamma knife radiosurgery may be a primary choice for patients with small tumours or medically inoperablly and a postoperative choice for patients after microsurgery. Gamma knife play an important role in controlling tumor recurrence and satisfactory quality of life with mild complications.