联合应用立体定向间质内放疗及γ-刀治疗复发性颅咽管瘤

Combination of stereotactic interstitial radiation with gamma knife surgery for relapsing craniopharyngiomas

目的 寻求手术后残留或复发颅咽管瘤的新治疗方法 ;并评价立体定向囊内间质内放疗结合伽玛刀 (γ 刀 )治疗的有效性和安全性。方法 应用立体定向囊内核素置入间质内放疗结合γ 刀治疗 82例手术后残留或复发的颅咽管瘤 ,其中男 5 4例 ,女 2 8例 ,年龄 3～ 70岁。对实体肿瘤为主者 ,先行囊内穿刺核素内放疗 ,再行γ 刀照射治疗共 2 1例 ;对囊性肿瘤为主者 ,则先行实体部分肿瘤γ 刀治疗 ,再行囊性部分的核素内放疗 ,共 6 1例。结果 70例患者接受 12～ 5 4个月 (平均 33.4个月 )的随访 ,对实体肿瘤为主、囊性肿瘤为主以及总有效控制率分别为 94 .1%、92 .5 %和 92 .9%。无手术死亡及严重并发症发生。结论 γ 刀结合立体定向囊内放射疗法 ,能够安全有效地治疗颅咽管瘤术后残留 。

Objective To find out a new approach for postoperative residual and recurrent craniopharyngiomas and to evaluate the effectiveness and the safety of the combination treatment with stereotactic interstitial radiation and gamma knife surgery.Methods Combination of treatment with stereotactic instillation of radioisotopes and gamma knife surgery was performed in 82 patients with postoperative residual and recurrent craniopharyngioma between October l996 and December 2001. There were 54 males and 28 females, and their ages ranged from 3 to 70 years (with an average of 31.5 years). Two procedures were performed in accordance with the patients' conditions. In 21 patients, the cyst part was treated with stereotactic interstitial radiation firstly, and MRI scanning and gamma knife surgery was added. In the remaining 61 cases, gamma knife surgery were applied for the solid part of the tumors and then stereotactic cystic fluid aspiration and intracavitary brachytherapy for the cystic part were performed.Results 70 patients were followed up from 12 to 54 months(mean 28.6 months). The tumor control rate (disappeared, decreased or unchanged) was 92.9% in total. No death and serious complications related to the operation were found.Conclusion The combination of stereotactic interstitial radiotherapy and gamma knife surgery can control the tumors successfully, and it represents a safe and effective method for postoperative residual and recurrent craniopharyngiomas.