中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2011年
10期
975-978
,共4页
孙时斌%刘阿力%罗斌%王美华%潘剑
孫時斌%劉阿力%囉斌%王美華%潘劍
손시빈%류아력%라빈%왕미화%반검
神经鞘瘤,听%伽玛刀治疗%长期随访研究
神經鞘瘤,聽%伽瑪刀治療%長期隨訪研究
신경초류,은%가마도치료%장기수방연구
Schwannoma,acoustic%Gamma knife radiosurgery%Long term follow-up studies
目的 探讨伽玛刀治疗(GKS)单侧听神经鞘瘤的长期临床疗效.方法 从1994年12月至2000年12月于天坛医院接受治疗超过10年的单侧听神经鞘瘤患者197例,随访到157例(随访率80.0％),平均年龄51.4(10～77)岁.首选GKS治疗者125例(79.6％),显微外科手术后再行GKS治疗者32例(20.4％).平均周边剂量12.7Gy(8.0～14.4 Gy),平均中心剂量28.8 Gy(20～40 Gy),治疗等中心点平均为4个(1～9个),平均体积5.1 cm3.平均随访时间6.3年(1- 15年),其中60例患者随访时间≥10年.结果 平均随访期6.3年,157例患者中93例肿瘤体积明显皱缩(59.2％),48例肿瘤体积无明显变化(30.6％),16例出现肿瘤发展伴临床症状加重(10.2％).肿瘤控制率89.8％,其中7例患者在随访过程中因其他病因死亡,伽玛刀控制肿瘤终生.肿瘤累积控制率3年为94％,5年为92％,10年为87％.听力累积保留率3年为94％,5年为85％,10年为64％.一过性面神经功能障碍16.6％,一过性三叉神经功能障碍17.8％,轻度面瘫1.3％,面部麻木2.5％.永久性明显的面神经及三叉神经功能障碍发生率为0.0％.结论 周边处方剂量12～14 Gy确实能长期控制中小体积听神经鞘瘤的肿瘤生长并保持良好的生存质量,随着随访时间的延长听力保留率有逐步下降趋势,对面神经及三叉神经功能有明显保留作用.因肿瘤的远期复发,长期随访不能终止.
目的 探討伽瑪刀治療(GKS)單側聽神經鞘瘤的長期臨床療效.方法 從1994年12月至2000年12月于天罈醫院接受治療超過10年的單側聽神經鞘瘤患者197例,隨訪到157例(隨訪率80.0％),平均年齡51.4(10～77)歲.首選GKS治療者125例(79.6％),顯微外科手術後再行GKS治療者32例(20.4％).平均週邊劑量12.7Gy(8.0～14.4 Gy),平均中心劑量28.8 Gy(20～40 Gy),治療等中心點平均為4箇(1～9箇),平均體積5.1 cm3.平均隨訪時間6.3年(1- 15年),其中60例患者隨訪時間≥10年.結果 平均隨訪期6.3年,157例患者中93例腫瘤體積明顯皺縮(59.2％),48例腫瘤體積無明顯變化(30.6％),16例齣現腫瘤髮展伴臨床癥狀加重(10.2％).腫瘤控製率89.8％,其中7例患者在隨訪過程中因其他病因死亡,伽瑪刀控製腫瘤終生.腫瘤纍積控製率3年為94％,5年為92％,10年為87％.聽力纍積保留率3年為94％,5年為85％,10年為64％.一過性麵神經功能障礙16.6％,一過性三扠神經功能障礙17.8％,輕度麵癱1.3％,麵部痳木2.5％.永久性明顯的麵神經及三扠神經功能障礙髮生率為0.0％.結論 週邊處方劑量12～14 Gy確實能長期控製中小體積聽神經鞘瘤的腫瘤生長併保持良好的生存質量,隨著隨訪時間的延長聽力保留率有逐步下降趨勢,對麵神經及三扠神經功能有明顯保留作用.因腫瘤的遠期複髮,長期隨訪不能終止.
목적 탐토가마도치료(GKS)단측은신경초류적장기림상료효.방법 종1994년12월지2000년12월우천단의원접수치료초과10년적단측은신경초류환자197례,수방도157례(수방솔80.0％),평균년령51.4(10～77)세.수선GKS치료자125례(79.6％),현미외과수술후재행GKS치료자32례(20.4％).평균주변제량12.7Gy(8.0～14.4 Gy),평균중심제량28.8 Gy(20～40 Gy),치료등중심점평균위4개(1～9개),평균체적5.1 cm3.평균수방시간6.3년(1- 15년),기중60례환자수방시간≥10년.결과 평균수방기6.3년,157례환자중93례종류체적명현추축(59.2％),48례종류체적무명현변화(30.6％),16례출현종류발전반림상증상가중(10.2％).종류공제솔89.8％,기중7례환자재수방과정중인기타병인사망,가마도공제종류종생.종류루적공제솔3년위94％,5년위92％,10년위87％.은력루적보류솔3년위94％,5년위85％,10년위64％.일과성면신경공능장애16.6％,일과성삼차신경공능장애17.8％,경도면탄1.3％,면부마목2.5％.영구성명현적면신경급삼차신경공능장애발생솔위0.0％.결론 주변처방제량12～14 Gy학실능장기공제중소체적은신경초류적종류생장병보지량호적생존질량,수착수방시간적연장은력보류솔유축보하강추세,대면신경급삼차신경공능유명현보류작용.인종류적원기복발,장기수방불능종지.
Objective The aim of this study was to assess the long term clinical outcomes of the gamma radiosurgery (GKS) for vestibular schwannomas (VS).Methods Duaring the period from December 1994 to December 2000,197 patients with VS received GKS more than 10 years and 157 patients were followed up with MRI( follow -up rate was 80.0％ ),which included 75 males and 82 females.The Leksell Gamma Knife models B was used.The mean age of the patients was 51.4 years( 10 to 77 years).GKS was applied as primary treatment for 125 cases(79.6％ ),and was an adjunctive management approach for 32 cases (20.4％ ).The mean peripheral dose was 12.7 Gy (range 8.0 ～14.4 Gy)and the mean central dose was 28.8 Gy(range 20～40 Gy).The mean volume was 5.1 cm3( range 0.037 ～ 27.300 cm3 ).The mean follow - up period was 6.3 years ( 1 - 15 years).Results Of this 157 cases,93 cases (59.2％ ) showed shrinkage,48 cases ( 30.6％ ) remained stable,16 cases ( 10.2％ ) showed tumor development,and the overall tumor control rate was 89.8％.7 cases died of other causes during the period of follow up and benefit from GKS all their lives.The actuarial 3 -years、5 -years and 10 years tumor control rate were 94％ 、92％and 87％ respectively.The actuarial 3 -years、5 -years and 10 years hearing preservation rate were 94％、85％ and 64％ respectively.The rate of permanent and marked facial paralysis and trigeminal neuropathies was 0.0％,the rate of transient facial paralysis was 16.6％,and the incidence of transient trigeminal neuropathies were 17.8％.Conclusion With a 12 ～ 14 Gy peripheral prescription dose,GKS was confirmed to have a long term tumor control for small to mediate sized and maintainance of a high quality of life,and could prevent cranial nerve from injury to a great extent.Duaring the long term follow -up period there might be not an end poit due to future reccurrence of VS.
