CRANIAL NERVE LENGTH PREDICTS THE RISK OF DELAYED FACIAL AND TRIGEMINAL NEUROPATHIES AFTER ACOUSTIC TUMOR STEREOTAXIC RADIOSURGERY
CRANIAL NERVE LENGTH PREDICTS THE RISK OF DELAYED FACIAL AND TRIGEMINAL NEUROPATHIES AFTER ACOUSTIC TUMOR STEREOTAXIC RADIOSURGERY
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DOI：
10.1016/0360-3016(93)90343-t
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发表时间：
1993-01-15
影响因子：
7
通讯作者：
LUNSFORD, LD
中科院分区：
文献类型：
--
作者：
LINSKEY, ME;FLICKINGER, JC;LUNSFORD, LD
目的：验证脑神经照射长度是预测放射外科手术后脑神经损伤风险的主要因素的假设，并确定其他有意义的治疗因素。方法与材料：1987年至1990年，92例(93个听神经瘤)患者接受了201源钴-60伽玛机治疗，并进行了前瞻性随访。肿瘤最小剂量为12~20Gy.最大剂量为24~50Gy.结果：在单因素分析(V=0.002，P=0.026)和多因素分析(P=0.055，V)和多因素分析(P=0.055)中，三叉神经病和面神经病的风险分别与脑室距离和中孔横瘤直径(解剖上分别与脑神经V和VII的照射长度相关)相关。在单因素和多因素分析中，肿瘤体积、其他肿瘤测量指标、最大剂量、最小肿瘤剂量和肿瘤剂量不均一性与三叉神经病或面神经病变无显著相关性。结论：在最小肿瘤剂量12~20GY范围内，延迟性三叉神经病或面神经病变的发生更多地依赖于估计的神经照射长度，而不是肿瘤剂量或肿瘤体积。将来，当肿瘤仍然具有较小的中孔横径和较小的桥岩距离时，通过实施放射外科手术，延迟性面部或三叉神经病的风险可能会显著降低。
Purpose: To test the hypothesis that length of cranial nerve irradiated is a major factor predicting the risk of cranial nerve injury following radiosurgery and to identify any other significant related treatment factors.Methods and Materials: Ninety-two patients (93 acoustic tumors) were treated with a 201 source Cobalt-60 gamma unit from 1987 to 1990 and prospectively followed. The range of minimum tumor dose was 12-20 Gy and maximum dose 24-50 Gy. Univariate and multivariate analyses were used to evaluate any correlations between tumor measurements and treatment factors, with the development of trigeminal and facial neuropathies following radiosurgery.Results: The risks of trigeminal and facial neuropathy following radiosurgery were associated with the pon-petrous distance and mid porous transverse tumor diameters respectively (anatomically related to the irradiated length of cranial nerves V and VII respectively) in both univariate (p = .002 for V and p = .026 for VII) and multivariate (p = .004 for V and p = .055 for VII) analyses. Tumor volume, other tumor measurements, maximum dose, minimum tumor dose, and tumor dose inhomogeneity Were not significantly related to either trigeminal or facial neuropathy in univariate and multivariate analyses.Conclusion: Within a minimum tumor dose range of 12-20 Gy, the incidence of delayed trigeminal or facial neuropathy depended more on the estimated length of nerve irradiated than the tumor dose or tumor volume. In the future, the risk of delayed facial or trigeminal cranial neuropathy may be reduced significantly by performing radiosurgery when the tumor still has both a small mid-porous transverse diameter and a small pons-petrous distance.