伽玛刀结合囊内照射治疗颅咽管瘤的临床疗效分析

Combination treatment for craniopharyngiomas with stereotactic intracavitary irradiation and gamma knife surgery

目的 探讨和评价伽玛刀结合立体定向放射性同位素囊腔内置入内放射治疗对颅咽管瘤的治疗效果。方法 对 46例确诊为颅咽管瘤的患者进行伽玛刀与立体定向放射性同位素囊内置入内放射治疗。其中男 2 4例 ,女 2 2例 ;年龄 3～ 6 0岁 ,平均 38 6岁。大实体小囊型肿瘤 13例 ,小实体大囊型 33例 ,2 8例接受过开颅手术。大实体小囊型行囊液穿刺后伽玛刀治疗 ,小实体大囊型则行联合治疗 ,伽玛刀治疗实体部分 ,立体定向同位素内放射治疗囊性部分。结果 38例获 6个月～ 2年(平均 16个月 )的随访 ,大实体小囊型的控制率为 90 0 % (4 1/ 46 ) ;小实体大囊型的控制率为 85 7%(39/ 46 )。实体成分的控制率为 92 1% (4 2 / 46 ) ,总控制率为 89 5 % (4 0 / 46 )。无严重并发症及手术死亡。结论 伽玛刀结合立体定向囊内放射治疗是治疗颅咽管瘤的一种简单、安全而且有效的方法 ,特别适合于手术后残留或复发不适宜手术治疗的囊实混合性肿瘤和距视神经有一定距离的实体性颅咽管瘤。

Objective To evaluate the effectiveness of the combination treatment for craniopharygiomas with stereotactic intracavitary irradiation and gamma knife surgery. Methods Combination treatment of stereotactic instillation of radioisotopes and gamma knife surgery was performed in 46 patients with craniopharyngioma between October 1996 and June 1999. There were 24 men and 22 women, with age ranging from 3 to 60 years (average 38.6 years). There were 13 solid tumors and 33 mixed solid and cystic tumors. Twenty eight patients had undergone prior caraniotomies with total or partial resection of tumors, with or without followed external beam radiation therapy. Gamma knife surgery was done in solid tumors and the combination treatment was done in mixed tumors: the cyst being treated with stereotactic intracavitary radiation and the solid part with Gamma knife. Results Thirty eight patients (10 solid and 28 mixed) were followed up from 6 months to two years(averaged 16 months). The tumor control rate (disappeared,decreased and unchanged) was 90% in solid tumor,85.7% in mixed tumors, and 92.1% in solid segment and the total control rate was 89.5%. Conclusion The combination treatment is a simple, safe and effective method for craniopharyngiomas, especially for the recurrent mixed solid and cystic tumors. Gamma knife surgery plays an important role in the treatment of solid component of the craniopharyngiomas.