大型海绵窦海绵状血管瘤的体积分割伽玛刀治疗

Volume-staged gamma knife radiosurgery for large cavernous sinus hemangioma

摘要:

目的 研究按体积分割分次伽玛刀治疗大型海绵窦海绵状血管瘤的治疗效果和副反应发生情况。方法 分析18例直径大于3 cm的海绵窦海绵状血管瘤患者，均采用体积分割的方式予以2~4次伽玛刀治疗，首次治疗一般选择肿瘤的基底部，边缘剂量为13 Gy，其后每次治疗间隔3~12个月，边缘剂量根据肿瘤的缩小情况以及解剖位置取12~13 Gy，并保证9 Gy的剂量曲线不与视神经和视交叉重合。结果 随访6~51个月，平均随访18个月，所有患者在第1次伽玛刀治疗后3~6个月就可见病灶明显缩小，5例患者在首次治疗3个月后病灶体积缩小25.3%~46.6%，平均缩小36.7%，13例患者首次治疗6个月后病灶体积缩小25.8%~65.5%，平均缩小47.1%。随着剩余分次伽玛刀治疗的完成，病灶继续缩小。所有患者在伽玛刀治疗后未出现临床症状加重以及新的神经功能受损，其中15例患者在第1次治疗后3~6个月后症状就得到改善，3例患者复查中症状无明显变化，症状改善率为83.3%。结论 采用从基底部开始的体积分割分次伽玛刀治疗大型海绵窦海绵状血管瘤是一种安全有效的治疗方式，在有效控制肿瘤生长的同时能改善患者的临床症状，可作为此类病变的主要治疗方式。

Abstract:

Objective To investigate the therapeutic effect and side effects of fractional gamma knife based on volume segmentation in the treatment of large cavernous sinus hemangioma.Methods A total of 18 patients with cavernous sinus hemangioma （with a diameter of greater than 3 cm） were selected and treated with gamma knife based on volume segmentation in 2-4 fractions. The first treatment generally selected the basal segment of tumor， with an edge dose of 13 Gy， and there was an interval of 3-12 months between the subsequent treatment sessions， with an edge dose of 12-13 Gy determined based on tumor reduction and anatomical position. It was also ensured that the 9 Gy dose curve did not overlap with the optic nerve and optic chiasm.Results The patients were followed up for 6-51 months， with a mean follow-up time of 18 months. A significant reduction in tumor volume was observed for all patients at 3-6 months after the first gamma knife treatment； at 3 months after the first treatment， 5 patients had the tumor volume reduced by 25.3%-46.6%， with an average reduction of 36.7%， and at 6 months after the first treatment， 13 patients had the tumor volume reduced by 25.8%-65.5%， with an average reduction of 47.1%. The tumor volume continued to decrease with the completion of the remaining fractions of gamma knife treatment. None of the patients showed aggravation of clinical symptoms or new neurological impairment after gamma knife treatment， and of all 18 patients， 15 patients had an improvement in symptoms at 3-6 months after the first treatment， and 3 patients showed no significant change in symptoms during reexamination， with a symptom improvement rate of 83.3%.Conclusions Fractional gamma knife based on volume segmentation starting from the basal segment of tumor is a safe and effective treatment method for cavernous sinus hemangioma and can effectively control tumor growth and significantly improve the clinical symptoms of patients， and therefore， it can be used as the main treatment method for such lesions.