伽玛刀放疗失败后听神经瘤的显微外科治疗

Microsurgical treatment of acoustic neuroma after failed gamma knife radiotherapy

摘要:

目的 探讨显微外科治疗伽玛刀放疗后进展的听神经瘤病例特点。方法 手术切除伽玛刀放疗后进展的听神经瘤患者构成伽玛刀放疗（GKR）组，对照组为未行伽玛刀治疗而行手术治疗患者，对比分析两组患者在临床特点和神经功能保留等方面的差别。结果 GKR组和对照组各纳入14例患者。术中发现GKR组肿瘤与周围神经血管粘连更为紧密。GKR组肿瘤全切率和面神经解剖保留率为92.9%和100%，而对照组均为100%。对照组的远期面神经功能显著优于GKR组。结论 全切除伽玛刀放疗后的听神经瘤依然可以获得理想的效果，对于初次治疗的听神经瘤患者，医生应慎重选择伽玛刀治疗，手术仍然是首选方案。

Abstract:

Objective To investigate the application of microsurgical treatment in acoustic neuroma after gamma knife radiotherapy, and to share the experience of Department of Neurosurgery in Xiangya Hospital.Methods The patients with acoustic neuroma who underwent surgical resection performed by Professor Yuan Xianrui in Department of Neurosurgery in Xiangya Hospital of Central South University were enrolled as gamma knife radiotherapy (GKR) group, and a control group was established. The two groups were compared in terms of clinical features and preservation of neurological function.Results There were 14 patients each in the GKR group and the control group. Severe adhesion between tumor and surrounding nerves and vessels was observed intraoperatively in the GKR group. The GKR group achieved a rate of total tumor resection of 92.9% and a rate of facial nerve preservation of 100%, while the control group achieved 100% for both rates. The control group had a significantly better long-term facial neurological function than the GKR group.Conclusions Total resection of acoustic neuroma after GKR can still achieve a satisfactory effect, but such patients have a poorer facial neurological function than those who do not undergo radiotherapy. For previously untreated patients with acoustic neuroma, clinicians should carefully choose gamma knife radiotherapy, and surgical treatment is still the preferred regimen.