脑内海绵状血管瘤的立体定向放射治疗

Stereotactic radiosurgery for cerebral cavernous angioma

目的 评估立体定向放射 (γ刀 )治疗脑内海绵状血管瘤的效果 ,探讨治疗的适应证和制定治疗计划的注意点。方法 回顾性分析 1994年至 1995年间 ,γ刀治疗的 5 7例脑内海绵状血管瘤 ,边缘剂量平均为 2 0 .6Gy(9.0～ 2 5 .2Gy)。 30 %～ 80 %的等剂量曲线包绕病灶。运用质子磁共振波谱进行脑坏死的鉴别。结果 5 3例随访 (4.38+1.40 )年 ,4例失访 ,1例死亡。影像随访中 19例见病灶缩小。 5例治疗后 4～ 39个月再次出血。 2 1例 (6 0 % )治疗后癫痫发作频度和程度减轻 ,6例主诉癫痫未改善。 4例额叶海绵状血管瘤患者停药后未再出现癫痫。 17例病灶位于额顶叶及颞叶内侧功能区的患者治疗后 4～ 2 5个月出现肢体肌力减退、失语等症状。 33例病灶周围出现中到重度水肿 ,经脱水、激素及尼莫通扩血管治疗 ,4～ 14个月后影像随访 ,脑水肿明显减轻好转。 5例出现明显的肢体活动障碍。 2例治疗后 14、16个月行手术切除病灶。 3例出现明显视力下降。结论 边缘剂量 >16Gy时治疗后再出血比率明显减低。从治疗后再手术切除的病理标本中未找到血管瘤内机化闭塞的确切证据。

Objective To evaluate the outcome and benefit of stereotactic radiosurgery (STRS) in cerebral cavernous angioma (CCA). Methods From 1994 to 1995, 57 CCA patients were treated by STRS with a mean peripheral dose of 20.6?Gy (9.0 ～25.2?Gy) and the isodose of 30% ～80%. Magnetic resonance spectroscopy (MRS) was used for differentiation of delayed cerebral necrosis. Results The median follow up duration was (4.38+1.40) years with 4 patients lost . The shrinkage of CCA lesion was demonstrated by radiologic image in 19 patients. Five of 23 patients with history of hemorrhage bled again 4 to 39 months after STRS. Of 25 patients with epilepsy,21(84%) showed alleviation of attacks both in frequency and severity but 6 were unimproved. Four patients with frontal cavernous angioma were cured with suspension of medicine. Seventeen patients with lesion in the frontal parietotemporal lobes developed neurological disability,such as weakness of muscular power and aphasia. Thirty three patients who recieved mannital, corticosteroids and nimotop for cerebral edema for 4 to 14 months showed improvement in the edema. Five resulted in severe neurological deficits and 3 in visual problems. Two received resection after STRS.Conclusions Higher dose (>16?Gy) of STRS seems to reduce the incidence of rebleeding after radiosurgery. However,there is no histopathologic evidence of vascular obliteration in the resected CCA specimens after radiosurgery. The benefits and risks must be carefully balanced before the use of radiosurgery for cerebral cavernous hemangioma.