伽玛刀治疗后并发症的临床病例分析

Complications following gamma knife radiosurgery

目的总结伽玛刀治疗后并发症的临床发展规律和神经影像学特点,探讨其易发因素和可能的发生机制。方法随访伽玛刀治疗后的动静脉畸形(AVM)、脑膜瘤、生殖细胞瘤、神经胶质细胞瘤、颅内转移瘤5种疾病共253例患者,总结分析急性期、亚急性期和晚期并发症的发生率以及靶组织的细胞增殖速度,AVM和脑膜瘤的病灶部位与并发症发生率的关系。结果5种疾病的并发症均多发生在亚急性期。晚反应组织和早反应组织、AVM中心型和周边型、脑膜瘤颅底型和非颅底型相比,亚急性期并发症发生率均有显著性差异。结论伽玛刀治疗引起的并发症多发生在亚急性期。多数急性期并发症具有自限性。放射线晚反应组织的亚急性期并发症发生率高于早反应组织。

Objective To investigate complication features following gamma knife radiosurgery(GKR), and to assess factors causing complications. Methods A retrospective analysis was conducted for 253 patients with intracranial arteriovenous malformation (AVMs), meningiomas, glial neoplasms, germinomas and metastatic cancer, respectively, which were treated with GKR.The incidences of acute, subacute and late complications following GKR were evaluated. Meanwhile, risk factors inducing subacute complications, such as the cell proliferative population of target tissues and location of target in AVM and meningioma, were evaluated, respectively. Results The subacute complications are the prominent reactions in all the five diseases. There is a significant difference in the incidence rate of subacute complications between early responding tissues and slow responding tissues, central and peripheral AVM, basal and nonbasal meningioma. Conclusions Subacute complications are the prominent reactions after GKR, and the reactions are almost always reversible. The risk of subacute complications following GKR treatment is correlated to the proliferative cell population in the target tissues and the target location (AVM, meningioma).