伽玛刀治疗颅内海绵状血管畸形的疗效研究

Therapeutic efficacy of gamma knife for cerebral cavernous malformations

目的分析伽玛刀治疗颅内海绵状血管畸形(CM)的疗效。方法回顾性分析112例颅内CM病人的临床资料,其中头痛、头晕68例,局灶性神经功能障碍60例,癫癎发作25例。均采用伽玛刀放射外科(GKRS)治疗,并进行随访。结果所有病人随访37-135个月,平均67个月。治疗后临床症状减轻或消失83例(74.1%),无变化20例(17.9%),加重9例(8.0%);癫癎发作完全消失9例,发作次数减少75%以上6例,减少>50%-75%4例,减少>25%-50%4例,发作次数减少≤25%或加重2例。MRI复查显示:病灶缩小或消失40例(35.7%),无变化68例(60.7%),增大4例(3.6%)。治疗后4-11个月出现脑水肿9例,其中仅有灶周水肿5例,合并再出血4例(3.6%);经治疗后均缓解。本组无死亡病例。治疗前病灶大小对癫癎治疗有效率、病灶缩小率和术后脑水肿发生率差异的影响均有统计学意义(P<0.05)。周边剂量对术后脑水肿影响有显著差异(P<0.05),但对癫癎治疗的有效率、病灶缩小率的影响无显著性差异(P>0.05)。结论 GKRS治疗颅内CM安全、有效,可减少癫癎发病率,降低再出血率,改善临床症状。

Objective To evaluate the therapeutic efficacy of gamma knife for cerebral cavernous malformations （CM）. Methods Clinical data of 112 patients with cerebral CM treated by gamma knife radiosurgery （GKRS） were analyzed retrospectively, including headaches and dizziness in 68, focal neurologic dysfunctions in 60 and epilepsy in 25. And the follow-up were performed in all the patients. Results All the patients were followed up for mean period of 67 months, ranged from 37 to 135 months. The clinical symptoms were improved or disappeared in 83 patients （74.1%）, not changed in 20 （17.9%） and aggravated in 9 （8.0%）. Seizures completely disappeared in 9 cases, and number of seizures reduced more than 75% in 6, reduced 50% to 75% in 4, reduced 25% to 50% in 4 and reduced below 25% or aggravated in 2. MRI reexamination showed that the lesion disappeared or diminished in 40 patients （35.7%）, not changed in 68 （60.7%） and enlarged in 4 （3.6%）. The cerebral edema occurred in 9 patients 4 to 11 months after the treatment, including only edema around the lesion in 5 cases and accompanied with cerebral hemorrhage in 4 （3.6%）, and all the patients remitted after symptomatic treatment. No patients died. The impact of pre-treatment lesion size to epilepsy treatment efficiency, the lesion reduction rate and the postoperative cerebral edema was statistically significant （P 〈 0.05）. The impact of the peripheral dose to postoperative cerebral edema had significant differences （P 〈 0.05）, but had no significant difference to epilepsy treatment efficiency, the lesion reduction rate （P 〉 0.05） Conclusion GKRS can reduce incidence rates of epilepsy and rebleeding and improve the clinical symptoms, thus being a safe and effective method for CM.