脑肿瘤伽玛刀治疗后再开颅切除原因分析

Analysis the reasons of resection of brain tumor after Gamma knife treatment

目的探讨伽玛刀治疗脑瘤后需要再开颅切除的原因。材料与方法结合临床表现特点，３７例伽玛刀治疗后均有不同程度的颅内压增高，局部颅神经损害加重，ＣＴ或ＭＲ复查脑瘤增大或水肿扩大，并通过手术切除肿瘤，解除颅高压或神经压迫症状。结果伽玛刀治疗前脑瘤直径大于３．０ｃｍ，肿瘤影响脑脊液循环，压迫脑干或重要颅神经损伤严重，脑肿瘤水肿严重，肿瘤恶性程度或复发是伽玛刀治疗后需开颅切除的重要因素。结论病理证实伽玛射线对脑肿瘤细胞具有致死性杀伤作用，但对周边瘤细胞，尤其是胶质瘤摧毁不彻底，提高伽玛刀治疗脑肿瘤疗效和减少并发症的关键在于掌握适应证和治疗技术。

Purpose To study the reasons of resection of brain tumor after Gamma knife treatment.Materials and Methods Deal with clinic feature,the 37 patients after Gamma knife treatment had different degree of intracranial hypertension,the injury of cranial nerve was deteriorated.Reexamined by CT or MR,the size of tumor and edema was enlarged.The patients had operation in order to remove tumors and relieve intracranial hypertension and compression symptom.Results If the diameter of tumor was above 3.0 cm before Gamma knife treatment ,the tumor could impair the circulation of cerebrospinal fluid and compress the brain stem or important cranial nerves,causing serious injury.Serious edema caused by tumor,the degree malignancy of tumor and recurrence of tumor were the important factors for resection after Gamma knife treatment.Conclusion Pathologic examine shows that Gamma rays have destructive effect on brain tumor cells.But Gamma rays can not destroy peripheral tumor cells thoroughly,especially for glioma.This suggests that the key points of the therapeutic effect of Gamma knife treatment on brain tumor are to master the indication and technique of the treatment.