显微外科手术和伽玛刀治疗海绵窦区脑膜瘤

Microsurgery and Gamma knife radiosurgery in treatment of cavernous sinus meningiomas

目的探讨显微外科手术切除和伽玛刀治疗海绵窦区脑膜瘤的有效性。方法回顾性分析2002年1月至2007年1月来我院接受治疗并获得完全随访资料的91例海绵窦脑膜瘤患者的治疗情况。41例肿瘤最大直径小于2～3cm,体积较小,无明显神经系统症状及颅内压增高表现,选择行伽玛刀治疗。50例肿瘤最大直径大于3cm,压迫、粘连视神经、视交叉,或脑干受压,伴有显著神经系统症状或颅内高压症状,先行显微外科手术治疗,术后残余患者补充伽玛刀治疗。治疗实施前后均进行眼肌功能评估。结果随访36～96个月。41例患者直接行伽玛刀治疗,有3例伽玛刀治疗后分别于第9、14、18个月出现水肿反应;有2例患者于治疗后第5年及第6年复发;伽玛刀治疗前及随访期间Biglan眼肌功能分级中优秀+良好的比率分别为63.4%、75.6%。50例手术患者,4例全切患者无一例复发;46例术后肿瘤残余补充伽玛刀治疗患者,3例分别于第4年、第5.5年及第7年复发;术前、术后短期及随访期间Biglan眼肌功能分级中,优秀+良好的比率分别为38%、44%和52%。结论海绵窦区脑膜瘤全切困难,对于体积较小的海绵窦区脑膜瘤,单纯伽玛刀治疗效果好,可作为主要的治疗手段,对于体积较大的海绵窦区脑膜瘤,采取手术和伽玛刀治疗,可有效降低海绵窦区脑膜瘤术后复发率,提高、保持患者的生存质量。

Objective To study the effect of microsurgery and Gamma knife radiosurgery for cavernous sinus meningiomas. Methods 91 cases of c.avernous sinus meningiomas were ana- lyzed retrospectively from January 2002 to January 2007.41 cases, the tumor＇s diameter were less than 2-3cm,and without significient intracranial hypertension or serious nervous system symp- toms,were treated with Gamma knife radiosurgery. Because of greater tumor＇s volume or with sig- nificient clinical symptoms, 50 cases were treated with upfront mierosurgery, remains received Gamma knife radiosurgery following resection. Biglan grading were used to analyze the variations of musculi oculi fuction at the points of before treatment, first week after operation and follow- up. Results All patients had follow-up of 36496 months. 3 of 41 cases treated with Gamma knife radiosurgery oecured edema at 9th, 14th, 18th month respectively, 2 of 41 cases displayed an increase in volume at 5th, 6th year. The ratio of excellent grade plus good grade in Biglan grading were 63.4% and 75.6G before treatment and in follow--up periods. The tumors were totally re- moved in 4 of 50 cases with the treatment of microsurgery. 46 of 50 cases received Gamma knife radiosurgery after operation because of remains,in which 3 cases were recurrence at 4th,5. 5th and 7th year respectively. The ratio of excellence grade plus good grade in Biglan grading were 38G, 44 % and 52 % respectively before operation , first week after operation and in follow-up periods. Conclusion Total resection is difficult to perform in cavernous sinus meningiomas, Gamma knife radiosurgery may be a primary choice for patient with small tumors. For patients with greater tumor＇s volume, microsurgery and Gamma knife radiosurgery can play an important role in con- trolling tumor recurrence and satisfactory quality of life, and they are helpful to improve the prog- nosis of the effected musculi oculi.