听神经瘤的伽玛刀治疗（附111例报告）

Gamma knife radiosurgery for vestibular schwannomas in 111 cases

目的总结伽玛刀（γ刀）放射外科治疗听神经瘤的效果。方法111例患者平均年龄为（46±18）岁，男性49例，女性62例；单侧病变97例，双侧14例；41例曾行手术治疗；75例γ刀治疗前存在有用听力；肿瘤直径为6～49mm，平均21．3mm；边缘剂量12—16Gy，平均13．14Gy，中心剂量24～32Gy。结果随访24—88个月，平均38．2个月；88例（79．3％）肿瘤缩小，18例（16．2％）大小无变化，5例（4．5％）肿瘤持续增大；治疗前存在有用听力的75例中21例（28％）听力下降；65例（86．7％）患者有用听力得到保留，其中19例（25．3％）较术前明显改善：26例（23．4％）出现患侧面瘫；7例（6．3％）出现三叉神经功能部分受损。结论1刀治疗听神经瘤有较高的肿瘤生长控制率和较高的神经功能保留率，是除显微外科手术外一种有效安全的治疗方法。

Objective To assess the results of gamma knife radiosurgery for vestibular schwannomas. Methods From July 1998 to July 2006, 111 cases of vestibular schwannomas were treaded with gamma knife. The 97 cases of them had solitary tumors; 14 cases with bilateral lesions. Prior resection had been performed in 41 patients. Facial nerve function was normal in 89 cases of the patients before radiosurgery, and 75 cases of them had serviceable hearing. Prescription peripheral dose varied from 12 to 16 Gy（mean 13.14 Gy） ; the corresponding central dose was 24 to 32 Gy. The mean diameter of the tumor at radiosurgery was 21.3 mm （range, 6 to 49 mm）. Results At a median follow up period of 38.2 months （range, 24 to 88 months）, tumor shrinkage was observed in 88 cases （79.3%）, and tumor size was sfable in 18 cases （16.2%）. Only 6 cases （5.4%） showed persistentradiographic evidence of progression. Deterioration of hearing was found in 21 out of 75 cases who had useful hearing before treatment,useful hearing was preserved in 65 patients, 19 cases（25.7% ） of which showed improvement in hearing. Conclusions Gamma knife radiosurgery prevents tumor growth, achieves excellent neurologic function preservation rates and few treatment- related comlications.