放射外科治疗海绵窦血管瘤的中长期疗效分析

Radiosurgery for cavernous sinus hemangiomas： medium- and long-term results

目的 总结放射外科（伽玛刀、射波刀）治疗海绵窦血管瘤（CSH）的中长期疗效,提出放射外科治疗CSH的优势.方法 应用伽玛刀或射波刀治疗CSH 20例,肿瘤最大径为23.0～60.6 mm,平均38.7 mm,肿瘤体积：4.1～52.6 cm3,平均18.7 cm3.伽玛刀照射肿瘤的周边剂量为9.0～16.0 Gy,平均12.3 Gy.射波刀治疗的4例CSH为巨大型肿瘤,照射肿瘤周边剂量20～21 Gy,采用分割成3次的治疗方案.随访时间为12～120个月,平均60个月.结果 治疗后所有病人均未出现新的颅神经受损症状,16例症状改善或恢复正常,4例无变化.伽玛刀治疗后5例肿瘤缩小90%以上,9例肿瘤缩小50%以上,1例略缩小,1例伽玛刀术后5个月开颅手术.射波刀治疗的4例肿瘤均缩小50%以上,无脑水肿发生.结论 放射外科治疗CSH不良反应轻,无颅神经损伤,长期疗效好,特别是射波刀分次照射,可以治疗大型或巨大CSH.

Objective To describe the personal experiences of treating cavernous sinus hemangiomas （CSH） with gamma knife or cyberknife and evaluate the medium and long-term outcomes.Methods From June 1999 to December 2008, 20 CSH patients were treated by radiosurgery （gamma knife or cyberknife）. Among them, 11 had residual tumor after surgery and 9 were diagnosed by neuroradiology.All cases on magnetic resonance imaging （MRI） showed well-defined and homogeneous hyperintensity on T2-weighted images. The mean maximum diameter of tumors was 38.7 ± 9.3 mm （range： 23.0 - 60.6）.The volume of tumors ranged between 4.1 - 52.6 cm3 with a mean of （18.7 ± 12.5） cm3. The tumor margin dose irradiated by gamma knife ranged from 9 to 16 Gy （mean 12.3 ±2.3 Gy）. The tumor margin dose irradiated by cyberknife was 20-21 Gy in 3 fractions. The mean follow-up period was （60 ± 32） months （range： 12 - 120）. Results Follow-up imaging showed tumor volume decreased over 90% （n= 5）, tumor regressed over 50% in volume （n = 9） and no change in tumor volume （n = 1）. One patient with large tumor （irradiated 10 Gy） was operated by open surgery at 5 months after gamma knife. Four giant tumors decreased over 50% in volume after cyberknife. Neurologically, none of these patients showed any deterioration. And 16 patients demonstrated an obvious improvement after radiosurgery. At the last followup, there were no complications related to radiosurgery. Conclusion Radiosurgery （Gamma knife or cyberknife） is a safe and effective modality for small- and medium-sized CSH. Fractionated Cyberknife proves to be an effective treatment for large or giant CSH. Thus radiosurgery will be an alternative option to surgery.