颅咽管瘤的伽玛刀治疗

Gamma Knife Radiosurgery for Craniopharyngiomas

目的 探讨伽玛刀治疗颅咽管瘤的疗效、适应证及并发症。方法 自1993年11月至2000年12月,使用伽玛刀治疗实体颅咽管瘤86例。其中50例行立体定向穿刺囊性部分,44例进行同位素^(32)P内放疗。治疗病灶体积0.7～26.9cm^3,平均5.37cm^3。中心剂量19.6～30Gy,平均24.6Gy。边缘剂量9.8～14Gy,平均12.4Gy。视神经和视束受照剂量小于10Gy。采用45％～55％等剂量曲线。结果 79例获随访,随访10～88个月,平均随访47个月。实体肿瘤部分控制率为88.6％(70/79),囊性部分控制有效率79.3％(50/63)。结论 手术切除仍是颅咽管瘤的首选治疗方法。伽玛刀治疗实质性颅咽管瘤,安全且有效,是手术切除后肿瘤残留复发和颅咽管瘤囊腔内同位素内放疗后等治疗手段的重要补充。对于不愿接受手术或不能耐受手术切除的患者,伽玛刀治疗也是有效的治疗选择。

Objective To explore the effects, indications and complications of Gamma Knife radiosurgery in the patients with craniopharyngiomas. Methods Eighty-six patients with solid craniopharyngiomas were treated with Leksell Gamma Knife from Nov. 1993 to Dec. 2000. Fifty cases with cystic segment received treatment with stereotactic Ommaya reservoir implantation, and 44 patients with intratumorous 32P radiotherapy. The tumor volume varied from 0.7 to 26.9 cm3 (average, 5.37 cm3). The central dose ranged from 19.6 to 30Gy (average, 24.6Gy). The mean marginal dose was 12.4Gy (range, 9.8Gy-14Gy) with an isodose of 45% to 55%, and the dose to the optic apparatus was limited to less than 10 Gy. Results The local control rate for the solid segments of craniopharyngiomas was 88.6% (70/79) and for cystic ones 79.3% (50/63) in 79 patients with craniopharyngiomas followed up for 10 to 88 months (average. 47 months). Conclusions Gamma Knife radiosurgery is a safe and effective adjuvant treatment method, although surgical resection is still the first choice for craniopharyngiomas. It is a reasonable option in the patients with recurrent or residual craniopharyngiomas, and a primary treatment for the patients who can not bear or be reluctant to do surgical resection.