伽玛刀治疗老年人静脉窦旁手术残余脑膜瘤的预后分析

Prognosis of Invading Venous Sinus Meningioma Treated by Gamma Knife after Non-radical Microsurgery in Elder Patients

目的：探讨应用伽玛刀治疗老年人手术后静脉窦旁残余肿瘤的疗效及预后。方法侵犯静脉窦脑膜瘤老年患者143例，应用显微手术联合伽玛刀治疗，其中手术（Simpson Ⅱ级）联合伽玛刀治疗52例，手术（Simp‐son Ⅲ～Ⅳ级）联合伽玛刀治疗49例，单纯手术（Simpson Ⅲ～Ⅳ）治疗42例。结果3组组间3年和5年疾病无进展期比较差别均有统计学意义（P＜0．05）；手术联合伽玛刀治疗的2组预后良好率和KPS评分改善率与单纯手术组差别有统计学意义（P＜0．05）。Cox回归分析显示，脑膜瘤复发与病理分级、手术切除程度及选择术后伽玛刀治疗有相关性。结论侵犯静脉窦的良性脑膜瘤老年患者在显微手术无法全切除肿瘤时，术后选择伽玛刀治疗能延长术后肿瘤无进展期。

Objective To investigate prognosis of invading venous sinus meningiomatreated by Gamma Knife after non‐radical microsurgery in elder patients . Methods Gamma Knife was admitted af‐ter microsurgery in 143 cases .Among these patients ,52 were treated with microsurgery （Simpson gradeⅡ） combined with Gamma Knife （group 1）;49 were treated with microsurgery （Simpson grade Ⅲ - Ⅳ） combined with Gamma Knife （group 2） and 42 were treated withmicrosurgery （Simpson grade Ⅲ - Ⅳ ） without Gamma Knife （group 3） .Total patients followed up 15~96 months . Result Significant differ‐ence of Progression Free Survival （PFS） of 3rd year and 5th year were observed among 3 groups （P〈0 .05） . Significant difference of GOS scores and Karnofsky Performance Scale （KPS） scores were observed in group 1 and group 2 compared with group 3（P〈0 .05） .Meningioma regrow were correlated to tumor grade ,the extent of surgical resection and selecting Gamma Knife by COX analysis （P〈0 .05） . Conclusion In eld‐er patients ,Gamma Knife could effectively control tumor regrow ,longer PFS and better long‐term progno‐sis after non‐radical microsurgery in invading venous sinus benign meningioma .