海绵窦海绵状血管瘤的影像学特点及伽玛刀治疗

Imaging diagnosis and gamma knife treatment of cavernous sinus cavernous hemangiomas

目的总结海绵窦海绵状血管瘤（CSHAs）的影像学特点，分析伽玛刀（γ刀）治疗的疗效。方法回顾性分析长期随访的16例应用ELEKTA Leksellγ刀治疗CSHAs的临床资料，其中6例为术后残留，2例仅术中活检，8例根据典型的影像学表现及后期随访诊断。肿瘤最大径为15．0～55．0mm，平均34．6mm，治疗周边剂量为8．0～15．0Gy，平均12．1Gy，等剂量曲线40％-60％，中心剂量16．0～32．5Gy，平均24．3Gy，随访时间6—96个月，平均40．5个月。结果γ刀治疗后所有患者均未出现新的永久性脑神经受损症状，其中2例在术后3—6个月左右出现短暂的轻度动眼神经麻痹症状。影像学结果：4例肿瘤几乎消失，10例明显缩小，2例变化不明显，无增大病例，其中1例于6个月后再次γ刀治疗（剂量分割），2例于术后2年因缩小不明显再次γ刀治疗，后期随访均明显缩小。结论Leksellγ刀治疗CSHAs安全可靠，疗效满意。γ刀是治疗术后残留、中小型（最大径≤40mm）及不能耐受手术CSHAs的有效方法之-。

Objective To summarize the imaging characteristic of cavernous sinus cavernous hemangiomas（ CSHAs ）, and evaluate the effects of Gamma Knife Radiosurgery （GKS） on CSHAs. Methods The clinical date of 16 patients with CSHAs were analyzed retrospectively, all cases were treated by GKS and with complete follow - up data in our hospital from September 2001 to December 2009. Of the 16 patients, 6 had residual tumor after surgery, 2 were biopsied, and 8 were diagnosed by neuroradiology and follow - up data in recent years. The mean maximum diameter of tumors was 34. 6 mm （ ranged 15.0 -55. 0 mm） ,the mean tumor margin dose was 12. 1 Gy （ranged 8. 0 - 15.0 Gy） at the isodose line from 40% to 60%, the mean max dose was 24. 3 Gy（ranged 16. 0 -32. 5 Gy）. The mean follow - up period was 40. 5 months （ranged 6 -96 months）. Results No patients suffered from a new and eternal cranical never deficit after GKS treatment. 2 patients suffered from transient oculomotor palsy among 3 months and 6 months. Imaging findings revealed： of the 16 tumors, 4 almost disappeared, 10 decreased markedly in size and 2 kept stable. 1 patient was treated again by GKS after 6 months, and 2 patients were treated again for tumors decreased not remarkable in size, these tumors all decreased markedly in follow - up. Conclusion GKS treatment can effectively control tumor growth with mild side - effects. It is one of the best treatment for postoperative tumor residual, small and middle - size CSHAs, or for patients who are not suitable for craniotomy.