伽玛刀治疗眼眶及眶颅沟通脑膜瘤中长期疗效分析与比较

A comparative study on medium-to-long term outcomes of gamma knife radiosurgery for orbital and cranio-orbital meningioma

摘要:

目的: 探究伽玛刀(γ-刀)治疗眼眶及眶颅沟通脑膜瘤的中长期疗效及差异.方法: 54例眼眶内及眶颅沟通脑膜瘤患者接受γ-刀治疗,其中眼眶内脑膜瘤32例,眶颅沟通脑膜瘤22例,肿瘤中位容积8.29 cm³(0.22~32.6 cm³),肿瘤边缘平均剂量4.2 Gy(10.0~17.0 Gy),40%~55%等剂量线.结果: 随访5~187个月,平均57个月,治疗后患者视力提高6例,维持不变31例,下降12例,失明5例;影像学显示肿瘤消失3例,缩小26例,无变化17例,增大8例,肿瘤总体控制率达85.2%,其中眶内脑膜瘤控制率90.6%,眶颅沟通脑膜瘤控制率77.3%.伽玛刀治疗后主要不良反应为眼部疼痛、眼睑肿胀、球结膜充血水肿等.结论: 伽玛刀治疗眼眶及眶颅沟通脑膜瘤具有长期控制肿瘤生长,可保留多数患者视力,并发症少等优点;眼眶内脑膜瘤在肿瘤控制及视力预后均好于眶颅沟通脑膜瘤.

Abstract:

Objective: To evaluate and compare the medium-to-long term outcomes of gamma knife stereotactic radiosurgery for orbital and cranio-orbital meningioma.Methods: The authors performed a retrospective study on 54 patients who received gamma knife stereotactic radiosurgery for orbital(32) or cranio-orbital(22) meningioma.The median tumor volume was 8.29 cm³(0.22~32.6 cm³).Patients were treated with a mean tumor marginal dose of 4.2 Gy(10.0~17.0 Gy) at the 40-55% isodose line.The average follow-up period was 57 months(5~187 months).Results: The overall tumor control rate was 85.2%(90.6% for orbital meningioma and 77.3% for cranio-orbital meningioma,respectively).Of those tumors,3 disappeared radiographically,26 decreased in size,17 remained stable,8 increased in size.Visual function as of the last follow-up was improved in 6,unchanged in 31,deteriorated in 12 and completely lost in 5 cases.The main adverse effects after treatment were ophthalmalgia,palpebral edema,and conjunctival congestion,etc.Conclusions: Gamma knife radiosurgery can achieve long-term tumor control for those two types of meningioma with relatively fewer side effects.Vision can be preserved in most cases.Orbital meningioma predicts better prognosis than cranio-orbital meningioma.