颅内肿瘤立体定向放射外科治疗后的再手术处理

Surgical intervention of brain tumors after stereotactic radiosurgery

目的对脑肿瘤病人经立体定向放射外科治疗(SRS)后需再手术的原因及处理方法进行分析。方法收集病例17例,其中恶性胶质瘤5例,肺癌脑转移3例,颅咽管瘤3例,听神经瘤2例,垂体瘤2例,脑膜瘤2例。结果8例为SRS治疗后出现放疗后脑水肿或脑积水,行肿瘤切除及减压术5例,脑室-腹腔分流术3例。5例为肿瘤继续长大,3例为治疗无效,均行肿瘤切除术。1例脑脊液鼻漏行脑脊液漏修补术。治疗后病情改善15例,死亡2例。结论脑肿瘤SRS后再手术处理的主要原因是放疗后脑水肿和肿瘤生长。SRS治疗应严格掌握适应证,及时处理并发症。

Objective To analysis the reasons of surgical intervention of brain tumors after stereotactic radiosurgery (SRS) for feasible treatments. Methods There were 17 patients treated from 1996 to 2002, consisting of 5 malignant gliomas, 3 brain metastasis, 3 craniopharyngiomas, 2 schwannomas, 2 meningiomas, 2 pituitary adenomas. Results The reasons of reoperation included radiation-induced edema, tumor growth, failing therapy, fistula of CSF. Patterns of operation included tumor resection, brain ventricle acupuncture, V-P shunt, CSF fistula repair. The patients undertook operation at 1 week to 72 month after SRS performed. There were 15 cases with complete or partial recovery and 2 deaths from tumor growth. Conclusion Radiation-induced edema and tumor growth are main causes of reoperation after SRS. Patients must be carefully assessed for SRS. The complications often occurred in the subacute phase following SRS and should be treated in time.