原发性眼眶静脉曲张的伽玛刀治疗(附14例分析)

Gamma knife radiosurgery for primary orbital varices:a preliminary report of 14 cases

目的探讨伽玛刀治疗原发性眼眶静脉曲张的方法与原则。方法回顾性分析14例原发性眼眶静脉曲张病人的治疗经验,主要表现均为体位性眼球突出,其中4例曾行手术治疗。病变容积1.9～9.0ml,平均(4.54±1.73)ml;边缘剂量15～20Gy,平均(16.64±1.34)Gy;视神经平均受照剂量(5.13±1.72)Gy。结果随访24～66个月,中位随访时间36个月。体位性眼球突出症状完全消失10例,明显改善2例,无变化2例;MRI、CT复查显示病变完全消失10例(71.4%)。病侧视网膜剥脱致视力丧失1例。结论伽玛刀对于原发性眼眶静脉曲张具有较好的治疗效果,可作为该病的首选治疗方法。

Objective To report the method and principle of Gamma knife radiosurgery for primary orbital varices. Methods The treatment experience of primary orbital varices in 14 patients with was retrospectively analyzed. Out of the 14 patients, 4 underwent surgical treatment for postural exophthalmus. The lesion volume at radiosurgery ranged from 1.9 to 9.0 ml, averaging 4.54±1.73 ml. Prescription peripheral dose varied from 15 to 20 Gy, averaging 16.64 ± 1.34 Gy. The average exposure dose of the optic nerve was 5.13 ± 1.72 Gy. Results At a median follow-up of 36 months （ranged from 24 to 66 months）, complete disappearance of presenting symptoms were seen in 10 cases, obvious symptom improvement in 2, and no change in 2. MRI or CT showed no evidence of orbital varices in 10 patients （71.4%）. One patient lost his eyesight because retinal detachment. Conclusion Gamma knife radiosurgery provides effective long-term relief of symptoms in selected patients with primary orbital varices, and can be its first choice.