STEREOTAXIC RADIOSURGERY OF CAVERNOUS SINUS MENINGIOMAS AS AN ADDITION OR ALTERNATIVE TO MICROSURGERY
STEREOTAXIC RADIOSURGERY OF CAVERNOUS SINUS MENINGIOMAS AS AN ADDITION OR ALTERNATIVE TO MICROSURGERY
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DOI：
10.1227/00006123-199305000-00001
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发表时间：
1993-05-01
期刊：
影响因子：
4.8
通讯作者：
FRIEDMAN, WA
中科院分区：
文献类型：
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作者：
DUMA, CM;LUNSFORD, LD;FRIEDMAN, WA
为了评估海绵窦脑膜瘤对立体定向放射外科手术的反应，我们回顾了 34 名患者 54 个月的经验。所有患者均接受了 201 源钴 60 伽玛装置的放射外科手术。 28 名患者 (82%) 之前曾进行过脑膜瘤的组织学证实（每位患者进行 1 至 5 次颅底开颅手术）； 6 名（18%）仅根据神经影像学标准进行治疗。单次放射肿瘤边缘剂量（10至20 Gy）的设计符合所有患者不规则的肿瘤体积。 31 名患者视神经或视束的最大辐射剂量减少至 9 Gy。在随访期间（中位时间 26 个月），没有患者出现肿瘤生长（100% 肿瘤控制）。平均 18 个月时进行影像检查的患者中有 56% 观察到肿瘤消退。八名患者（24%）在随访检查中临床情况有所改善。随访期间，四名患者出现新的或恶化的脑神经缺损；两个随后得到全面改善。没有患者出现内分泌病或新的眼外肌麻痹。立体定向放射外科使用伽玛装置辅助的多个等中心剂量测定，是一种准确、安全、有效的技术，可预防涉及海绵窦的肿瘤生长。尽管此类肿瘤靠近邻近的脑神经，但并发症很少见。住院时间最长为36小时，所有患者均在3至5天内恢复至术前就业状态。尽管需要更长时间的随访，但使用伽马刀技术的立体定向放射外科手术被发现是一种低发病率的替代方案，可以替代积极的显微手术切除海绵窦中小型肿瘤。
TO EVALUATE THE response of cavernous sinus meningiomas to stereotactic radiosurgery, we reviewed our 54-month experience with 34 patients. All patients underwent radiosurgery with a 201-source cobalt-60 gamma unit. Twenty-eight patients (82%) had previous histological confirmation of a meningioma (1 to 5 cranial base craniotomies per patient); 6 (18%) were treated on the basis of neuroimaging criteria alone. The single-fraction radiation tumor margin dose (10 to 20 Gy) was designed to conform to the irregular tumor volumes in all patients. The maximum radiation dose to the optic nerve or tract was reduced to 9 Gy in 31 patients. No patient had tumor growth (100% tumor control) during the follow-up interval (median, 26 mo). Tumor regression was observed in 56% of patients imaged at an average of 18 months. Eight patients (24%) improved clinically at follow-up examinations. Four patients developed new or worsened cranial nerve deficits during the follow-up interval; two had subsequent full improvement. No patient developed an endocrinopathy or new extraocular muscle paresis. Stereotactic radiosurgery, using multiple isocenter dosimetry facilitated by the gamma unit, is an accurate, safe, and effective technique to prevent the growth of tumors involving the cavernous sinus. Despite the proximity of such tumors to adjacent cranial nerves, complications were rare. The maximum length of hospital stay was 36 hours, and all patients returned to their preoperative employment status within 3 to 5 days. Although even longer follow-up is required, stereotactic radiosurgery using the gamma knife technique was found to be a low-morbidity alternative to aggressive microsurgical removal of small to moderate-sized tumors of the cavernous sinus.