海绵窦区的肿瘤及伽玛刀治疗

Gamma knife surgery for tumors involving cavernous sinus

目的 探讨各种海绵窦区肿瘤的诊断特点以及伽玛刀放射外科治疗的作用。方法 本文回顾性地分析我中心 1994年至 2 0 0 0年底用Leksell伽玛刀治疗的 175例累及海绵窦肿瘤的临床材料 ,其中 90例 (5 1 4% )患者有开颅手术史 ;总结了各种肿瘤的鉴别诊断及伽玛刀治疗的经验。结果 本组 82 3%的病人随诊 1～ 84个月 ,平均 32 5个月。主要良性肿瘤的总有效控制率达 94 0 % ;3例因肿瘤再生长开颅手术治疗。伽玛刀治疗海绵窦转移瘤的近期疗效显著 ,患者平均 1年后的死因皆非海绵窦病灶所致。结论 伽玛刀可以作为海绵窦区小型良性肿瘤 ,或手术后残存肿瘤的主要的治疗手段 ;对已造成神经功能障碍的海绵窦区的转移瘤 ,伽玛刀也被认为是重要的综合治疗方法之一。

Objective To study the feature of diagnosis and radiosurgery of all kinds of tumors involving cavernous sinus. Methods From December 1994 to the end of 2000, 175 patients with cavernous sinus lesions were treated by Leksell gamma knife in our institute. Ninety patients(51 4%) had open surgery previously. We analyzed the experience of treating cavernous sinus tumors by gamma knife. Results Follow up periods for the 82 3% patients ranged from 1 to 84 months (median 32 5 months), total tumor control rate was 94%. Surgical resection was performed after radiosurgery in 3 patients, because of tumor enlargement. For metastatic tumor in cavernous sinus which was high sensitive to irradiation, most of the lesions shrunk obviously in 2～3 months on MRI after gamma knife surgery. The median survival time was 12 2 months and none of the patients died of cavernous sinus lesions. Conclusions Gamma knife surgery is a main option for those small benign and residual tumors involving cavernous sinus, with high tumor control rate and fewer complications. It is also a very useful method for comprehensive therapy of metastatic tumors in cavernous sinus.