伽玛刀和立体定向^(32)P囊内放疗联合治疗颅咽管瘤

Combined Gamma Knife Surgery and Stereotactic Intracystic Radiotherapy of Colloidal (32)~P for Treatment of Craniopharyngiomas

对1993年11月～1997年8月本院治疗的42例颅咽管瘤进行回顾性研究.42例均为囊性-实质性肿瘤,平均直径为32mm,平均体积为12688mm^3,采用伽玛刀治疗肿瘤的实质部分,平均中心剂量26Gy,周边剂量为13Gy,囊性部分行~32P内放射治疗,平均~32P量为 0.944mci.对早期治疗的16例病人进行随访,平均时间为31个月.术后短期观察无放射和手术相关的并发症,随访结果显示:88%的肿瘤有不同程度的缩小.症状改善61%,症状不变为37%,但视力和视野恢复不明显,另外1例于注射~32P胶体3个月后出现动眼神经损害.伽玛刀结合~32P治疗颅咽管瘤是一种安全有效.创伤较小的治疗方法,有临床使用价值.

Forty two cases of craniopharyngiomas, treated by Gamma knife surgery and stereotactic intracystic radiotherapy of colloidal 32P through Ommaya reservoir between November 1993 and August 1997,were retrospectively reviewed. All lesions were mixed solid and cysts with mean diameter 32mm and mean volume 12 688 mm3(including cystic component). The solid part was treated with Gamma knife and received mean maximum dose of 26 Gy and peripheral dose of 13 Gy. Intracystic colloidal 32P injection was administered to the cystic part with mean dose of 0. 944mci. Follow-up was carried out in 16 cases with mean period of 31 month. No patient died, no case suffered from complications related to the radiosurgery and the needle puncture. Except for one patient with oculomotor nerve palsy three months after 32P injection and moderate improvement in visual acuity/field deficits, the follow-up results showed improvement of symptoms/signs (61%) and radiological evidence of tumor regression (88%). These results suggested that Gamma knife surgery plus stereotactic intracystic radiotherapy of colloidal 32P through Ommaya reservoir was a safe and effective and minimal-ly invasive treatment, which should be considered as the initial surgery for mixed solid and cystic craniopharyngiomas.