眼眶肿瘤的伽玛刀放射外科治疗

Gamma knife radiosurgery for orbital tumors

目的总结评价Leksell伽玛刀治疗眼眶肿瘤的中长期疗效。方法223例患者年龄4～85岁，平均（37．5±15．6）岁。男91例，女132例；125例为手术后残留或复发者，98例根据典型临床及影像表现进行诊断；肿瘤容积0．03～35．60cm3，平均（5．4±1．9）cm3；肿瘤边缘剂量10～40Gy。结果随访18—114个月，平均（35．7±16．2）个月，肿瘤缩小129例（57．8％），无变化80例（35．9％），14例（6．3％）肿瘤增大，肿瘤控制率为93．7％；142例患者治疗后视力得到保留，其中视力提升79例，减退19例；21例曾出现一过性球结膜水肿。结论伽玛刀治疗眼眶肿瘤可取得良好肿瘤控制率，多数患者可保留视力，并发症少，可成为眼眶肿瘤的主要治疗方法之一。

Objective The authors evaluate their results when using gamma knife surgery （GKS） in the management of patients with orbital tumors. Method Clinical evaluation of 223 patients with orbital tumors treated with GKS from Sep 1995 through Oct 2009 was analyzed retrospectively. The series included 91 male and 132 female patients with a mean age of （37.5 ±15.6） years （range 4 -85 years）. The diagnoses were based on pathological analyses in 125 patients, and presumed by characteristic clinical and radiographic findings in 98 patients. There were 94 meningiomas, 45 epithelial tumors of the lacrimal gland, 25 schwannomas, 20 malignant choroidal melanomas, 12 optic nerve gliomas, 11 orbital metastases, 10 pseudotumors of the orbit, 3 retinoblastomas and 3 fibromatosis. The median target volume was 5. 4 cm3 （range 0. 03 - 35. 60 cm3 ）. The tumor margin dose ranged from 10 to 40 Gy. Results At a median follow - up period of （ 35. 7 ±16. 2 ） months （range, 18 to 114 months）, tumor shrinkage was observed in 129 patients （57. 8% ）, and the tumor size was stable in 80 （35. 9% ）. Persistent neuroimaging demonstrated evidence of progression in only 14 patients （6. 3% ） ： i0 cases underwent repeated GIgS and 4 accepted surgical treatment. Visual acuity was preserved in 142 patients. 79 patients experienced some degree of visual sight improvement. Severe deterioration of visual acuity was found in 19 of 161 patients who had useful visual sight before treatment. 21 patients （9. 4% ） experienced transient conjunetival edema, no other serious acute side effect was observed. Conclusions Gamma knife provides an effective management strategy in patients with orbital tumors; it aehives excellent neurological founction preservation and few treatment -related complications.