射波刀分次治疗海绵窦海绵状血管瘤的中长期结果

Multisession cyberknife radiosurgery for cavernous sinus hemangiomas： medium-and long-term outcomes

目的 探讨射波刀分次治疗海绵窦海绵状血管瘤（CSH）的中长期效果.方法 2008年1月至2012年2月共45例CSH患者在复旦大学附属华山医院接受了射波刀分次治疗,其中男性10例,女性35例;年龄26 ～ 80岁,平均53岁.肿瘤最大径23.0 ～ 75.0 mm,平均47.0 mm.肿瘤体积2.9～140.1 cm3,平均40.1 cm3.2例小型肿瘤（体积≤5.0 cm3）照射1次,4例中型肿瘤（5.0 cm3＜体积＜ 10.0 cm3）照射2次,28例大型肿瘤（10.0 cm3≤体积＜ 40.0 cm3）照射3次,11例巨大肿瘤（体积≥40.0 cm3）照射4次.患者治疗结束后每6个月随访1次,进行MRI检查,评估临床症状改善及肿瘤局部控制情况.结果 患者均获随访,随访时间22 ～ 70个月,平均37.7个月.射波刀治疗后3年1例死于脑梗死,但是肿瘤缩小.8例巨大肿瘤在治疗后有轻微的症状加重,经脱水治疗症状消失.所有患者均未出现新的颅神经受损症状,而原有症状均改善.15例患者肿瘤体积缩小＞80％,18例（包括1例死亡者）体积缩小＞60％～80％,12例肿瘤体积缩小40％ ～ 60％.2例出现癫痫,予抗癫痫药对症处理后症状完全消失.结论 射波刀分次治疗CSH安全有效,中长期疗效好.

Objective To investigate the medium-and long-term outcomes of multisession cyberknife radiosurgery intreating cavernous sinus hemangiomas （CSH）.Methods Between January 2008 and February 2012,45 patients with CSH,including 35 female and 10 male patients with a mean age of 53 years （range：26-80 years）,underwent multisession cyberknife radiosurgery.The mean diameter of the CSH was 47.0 mm （range：23.0-75.0 mm）.The tumor volume ranged from 2.9 to 140.1 cm3,with a mean of 40.1 cm3.Eleven giant CSH with tumor volume ≥ 40.0 cm3 were irradiated by cyberknife in 4 fractions,28 large tumors with tumor volume 10.0-40.0 cm3 in 3 fractions,4 tumors with tumor volume 5.0-10.0 cm3 in 2 fractions,2 small tumors with tumor volume ≤5.0 cm3 in 1 fraction.After the treatment,all patients had regular clinical and radiological follow-up at 6-month intervals.A combination of the neurologic examination and MRI information was used to evaluate the overall response.Results All patients were followed up for 22-70 months with a mean of 37.7 months.One patient died of stroke 3 years post cyberknife,but the follow-up MRI showed that the CSH shrank in volume.Eight patients with giant CSH had slight headache after finishing cyberknife radiosurgery,and relieved with mannitol and dexamethasone treatment.Neurological deficits in patients had improved or disappeared at 6 to 12 months post cyberknife.None of these patients showed any deterioration in symptoms or new cranial nerve deficits during the follow-up.Latest follow-up imaging demonstrated that tumors decrease 〉 80% in 15 patients,〉 60% to 80% in 18 patients（including the death patient）,40%-60% in 12 patients post cyberknife.Two patients reported occurrence of seizures and maintaining seizure control after antiepileptic drugs administration.Conclusions Multisession cyberknife radiosurgery is confirmed to provide medium and long-term local tumor control and symptom improvement.It is a safe and effective treatment modality for CSH,and may serve as a promising treatment option in the future.