CAJ | 학술논문

目的总结放射外科(伽玛刀、射波刀)治疗海绵窦血管瘤(CSH)的中长期疗效,提出放射外科治疗CSH的优势.方法应用伽玛刀或射波刀治疗CSH 20例,肿瘤最大径为23.0～60.6 mm,平均38.7 mm,肿瘤体积:4.1～52.6 cm3,平均18.7 cm3.伽玛刀照射肿瘤的周边剂量为9.0～16.0 Gy,平均12.3 Gy.射波刀治疗的4例CSH为巨大型肿瘤,照射肿瘤周边剂量20～21 Gy,采用分割成3次的治疗方案.随访时间为12～120个月,平均60个月.结果治疗后所有病人均未出现新的颅神经受损症状,16例症状改善或恢复正常,4例无变化.伽玛刀治疗后5例肿瘤缩小90%以上,9例肿瘤缩小50%以上,1例略缩小,1例伽玛刀术后5个月开颅手术.射波刀治疗的4例肿瘤均缩小50%以上,无脑水肿发生.结论放射外科治疗CSH不良反应轻,无颅神经损伤,长期疗效好,特别是射波刀分次照射,可以治疗大型或巨大CSH.
목적 총결방사외과(가마도、사파도)치료해면두혈관류(CSH)적중장기료효,제출방사외과치료CSH적우세.방법 응용가마도혹사파도치료CSH 20례,종류최대경위23.0～60.6 mm,평균38.7 mm,종류체적:4.1～52.6 cm3,평균18.7 cm3.가마도조사종류적주변제량위9.0～16.0 Gy,평균12.3 Gy.사파도치료적4례CSH위거대형종류,조사종류주변제량20～21 Gy,채용분할성3차적치료방안.수방시간위12～120개월,평균60개월.결과 치료후소유병인균미출현신적로신경수손증상,16례증상개선혹회복정상,4례무변화.가마도치료후5례종류축소90%이상,9례종류축소50%이상,1례략축소,1례가마도술후5개월개로수술.사파도치료적4례종류균축소50%이상,무뇌수종발생.결론 방사외과치료CSH불량반응경,무로신경손상,장기료효호,특별시사파도분차조사,가이치료대형혹거대CSH.
Objective To describe the personal experiences of treating cavernous sinus hemangiomas (CSH) with gamma knife or cyberknife and evaluate the medium and long-term outcomes.Methods From June 1999 to December 2008, 20 CSH patients were treated by radiosurgery (gamma knife or cyberknife). Among them, 11 had residual tumor after surgery and 9 were diagnosed by neuroradiology.All cases on magnetic resonance imaging (MRI) showed well-defined and homogeneous hyperintensity on T2-weighted images. The mean maximum diameter of tumors was 38.7 ± 9.3 mm (range: 23.0 - 60.6).The volume of tumors ranged between 4.1 - 52.6 cm3 with a mean of (18.7 ± 12.5) cm3. The tumor margin dose irradiated by gamma knife ranged from 9 to 16 Gy (mean 12.3 ±2.3 Gy). The tumor margin dose irradiated by cyberknife was 20-21 Gy in 3 fractions. The mean follow-up period was (60 ± 32) months (range: 12 - 120). Results Follow-up imaging showed tumor volume decreased over 90% (n= 5), tumor regressed over 50% in volume (n = 9) and no change in tumor volume (n = 1). One patient with large tumor (irradiated 10 Gy) was operated by open surgery at 5 months after gamma knife. Four giant tumors decreased over 50% in volume after cyberknife. Neurologically, none of these patients showed any deterioration. And 16 patients demonstrated an obvious improvement after radiosurgery. At the last followup, there were no complications related to radiosurgery. Conclusion Radiosurgery (Gamma knife or cyberknife) is a safe and effective modality for small- and medium-sized CSH. Fractionated Cyberknife proves to be an effective treatment for large or giant CSH. Thus radiosurgery will be an alternative option to surgery.