18例眼眶静脉性血管瘤γ刀治疗疗效观察

The Medium and Long-term Follow-up of Gamma Knife Surgery for 18 Cases of Orbital Venous Angioma

目的:总结评价18例眼眶静脉性血管瘤γ刀治疗的中长期疗效。方法:18例患者中位年龄15岁(2～54岁),其中男8例,女10例;12例(66.7%)系既往手术后复发患者;临床表现:眼球突出17例,双侧眼球突出度差距平均3.4mm(1～13mm),4例失明;肿瘤容积1.0～30.2cm^3,平均7.3±3.5cm^3;均行MRI定位扫描;边缘剂量15～20Gy,中心剂量30～40Gy;50%等剂量曲线包绕病灶;视神经平均受照剂量6.3±1.7Gy;等中心数7～16个,平均11个。全组患者均无放射治疗史。结果:随访30～120个月,中位时间56个月,复查MRI显示肿瘤全部缩小,其中13例肿瘤体积缩小超过50%,全组患者突眼症状消失,治疗后平均容机2.23±1.05cm^3;治疗后视力提升11例(61.1%),无变化5例(27.8%),减退2例(11.1%),无γ刀治疗后失明患者;随访期内无1例出现肿瘤复发、肿瘤出血或导血管栓塞;4例曾出现一过性球结膜水肿。结论:γ刀治疗眼眶静脉性血管瘤可长期控制肿瘤生长,可保留部分视力,并发症较少,为术后残留或复发的患者提供了进一步治疗的方法,也可作为静脉性血管瘤的主要治疗方法之一。

Objective： This retrospective study was undertaken to assess the medium and long term resultsof Gamma Knife surgery （GKS） for 18 patients with orbital venous angioma. Methods： All patients were treatedwith Leksell Gamma Knife between September 1995 and September 2004. The study included 8 males and 10females with a median age of 15 （range 2-54） years. Twelve patients （66.7%） had recurrent or residual tumorsafter prior surgical resection, while GKS was performed as the initial treatment in 6 patients （33.3%）. Seventeenpatients in this group had an average proptosis measurement of 3.4 mm （range, 1-13 mm）. Five patients werecompletely blind before GKS. All patients had stereotactic magnetic resonance imaging （MRI） before treatment.The prescribed peripheral dose varied from 15 to 20 Gy （mean 16.7 Gy） and the corresponding central dose was30 to 40 Gy. The mean radiation dose to the optic nerve was 6.3±1.7 Gy. The mean volume of the tumor at GKSwas 7.3±3.5 cm3 （ ranged 1.0 to 30.2 cm3）. An average of 11 isocenters （ranged 7 to 16） was used for treating thelesions. No patients had received prior brain irradiation. Results： Patients underwent follow-up examination at6-month intervals after GKS. At a median follow-up period of 56 months （ranged 30 to 120 months）, tumorshrinkage was observed in all patients, and the shrinkage was over 50% in 13 patients. The mean volume of thetumor at final follow-up was 2.23±1.05cm3. Exophthalmos was improved in all patients. Visual acuity was improvedin 11 patients, remained stable in 5 patients （including 1 patient who was completely blind before GKS） anddeteriorated in 2 cases. All patients had an improvement in their symptoms. Except for reversible conjunctivaledema in 4 cases, no other serious acute adverse effects were observed. No further tumor enlargement wasobserved after GKS. Conclusion： Gamma knife radiosurgery is an effective treatment for orbital venous angioma.It provides medium and long term tumor control and visual preservation with low toxicity. GKS may become astandard treatment approach in selected cases of orbital venous angioma.