Roche P-H, Pellet W, Fuentes S, Thomassin J-M, Régis J
Unité d'Otoneurochirurgie, CHU La Timone, Marseille, France.
Acta Neurochir (Wien). 2003 Oct;145(10):883-8; discussion 888. doi: 10.1007/s00701-003-0123-1.
Surgical treatment of petroclival meningiomas remains challenging. In order to refine indications for the use of stereotactic radiosurgery in the treatment of these tumours, we retrospectively evaluated our experience in this field.
Thirty-two patients harboring a petroclival meningioma were treated consecutively using a Gamma knife between December 92 and June 1998. Eight patients underwent radiosurgery after one or more attempted surgical removals and 24 had radiosurgery as the primary treatment. The main symptoms before radiosurgery were cranial nerve palsies, including a sixth nerve deficit in 10 patients and a trigeminal nerve disturbance in 9. All patients underwent a conformal multi-isocentric treatment (mean isocenter's number 8.8) and the dose delivered at the tumour margin ranged from 10 to 15 Gy (mean dose 13 Gy).
The duration of follow-up varied from 24 to 118 months (mean clinical follow-up 56 months, mean radiological follow-up 52.6 months). All 32 patients survived. The tumour volume remained unchanged in 28 patients and decreased slightly in 4. Neurological status worsened permanently in 2 patients with a delayed hemiparesis due to focal pontine infarction. These complications were associated with large meningiomas with vascular involvement and ventral brainstem compression, and occurred at the very early stage of our experience. At last follow-up, preoperative fifth or sixth cranial nerve deficits had improved or recovered in 13 out of 19 patients and any delayed worsening or new cranial nerve deficits were not observed after radiosurgery.
Stereotactic radiosurgery with a Gamma knife provides effective management of small to middle sized petroclival meningiomas and is an alternative to microsurgery. Careful selection of patients and use of major technical refinements should improve the safety of this treatment.
岩斜区脑膜瘤的手术治疗仍然具有挑战性。为了完善立体定向放射外科治疗这些肿瘤的适应证，我们回顾性评估了我们在该领域的经验。
1992年12月至1998年6月期间，连续32例岩斜区脑膜瘤患者接受了伽玛刀治疗。8例患者在一次或多次手术切除尝试后接受了放射外科治疗，24例患者接受放射外科作为主要治疗方法。放射外科治疗前的主要症状为颅神经麻痹，其中10例患者有第六神经功能缺损，9例患者有三叉神经功能障碍。所有患者均接受了适形多中心治疗（平均等中心数8.8），肿瘤边缘给予的剂量范围为10至15 Gy（平均剂量13 Gy）。
随访时间从24个月至118个月不等（平均临床随访56个月，平均影像学随访52.6个月）。32例患者均存活。28例患者肿瘤体积保持不变，4例患者肿瘤体积略有减小。2例患者因局灶性脑桥梗死出现迟发性偏瘫，神经功能状态永久性恶化。这些并发症与累及血管和压迫脑干腹侧的大型脑膜瘤有关，且发生在我们经验的早期阶段。在最后一次随访时，19例患者中有13例术前第五或第六颅神经功能缺损得到改善或恢复，放射外科治疗后未观察到任何迟发性恶化或新的颅神经功能缺损。
伽玛刀立体定向放射外科为中小型岩斜区脑膜瘤提供了有效的治疗方法，是显微手术的一种替代方案。仔细选择患者并采用主要技术改进措施应能提高该治疗方法的安全性。
