Linskey M E, Lunsford L D, Flickinger J C, Kondziolka D
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Neurosurg Clin N Am. 1992 Jan;3(1):191-205.
Stereotactic radiosurgery is an important alternative treatment for carefully selected patients with acoustic tumors. We perform radiosurgery under local anesthesia, and 91% of our patients have been discharged from the hospital within 24 hours after treatment. All returned to their preoperative level of function or employment within 5 to 7 days after treatment. Our current tumor control rate is 97%, but reduction in tumor size, judged by strict, objective criteria, was achieved in only 23%. Our actuarial rate of useful hearing preservation after radiosurgery is 38% at 1 year. Three tumors increased in size after treatment. Only one of the three demonstrated increased mass effect on surrounding brain structures by neuroimaging criteria. No increase has led to worsened clinical symptoms or has required surgical excision at this point in follow-up. The 1-year rates for developing new facial or trigeminal neuropathies after radiosurgery were 30% and 33%, respectively. Cranial neuropathies had a delayed onset, with the median onset occurring after 5 to 6 months. The vast majority were partial at onset, and most improved over time. Communicating hydrocephalus requiring ventriculoperitoneal shunts developed after radiosurgery in four patients. Eight patients developed increased signal within adjacent brain parenchyma on T2-weighted MR imaging, consistent with edema or blood-brain barrier breakdown. It is unlikely that stereotactic radiosurgery using the gamma knife will obviate the need for microsurgical removal performed by skilled and experienced microsurgeons. However, radiosurgery is a safe and effective treatment for patients whose medical problems make surgery unacceptably dangerous, those with bilateral tumors or a tumor in their only hearing ear, those who have recurrent tumor despite surgical resection, or patients who refuse microsurgical excision.
立体定向放射外科手术是精心挑选的听神经瘤患者的一种重要替代治疗方法。我们在局部麻醉下进行放射外科手术，91%的患者在治疗后24小时内出院。所有患者在治疗后5至7天内恢复到术前的功能水平或重返工作岗位。我们目前的肿瘤控制率为97%，但按照严格的客观标准判断，肿瘤体积缩小的仅占23%。我们的放射外科手术后1年有用听力保留的精算率为38%。有3个肿瘤在治疗后体积增大。在这3个肿瘤中，只有1个通过神经影像学标准显示对周围脑结构的占位效应增加。在随访的这个阶段，没有一个增大导致临床症状恶化或需要手术切除。放射外科手术后1年出现新的面部或三叉神经病变的发生率分别为30%和33%。颅神经病变起病较晚，中位起病时间在5至6个月后。绝大多数在起病时为部分性病变，且大多数随时间改善。4例患者在放射外科手术后发生需要脑室腹腔分流术的交通性脑积水。8例患者在T2加权磁共振成像上显示相邻脑实质内信号增强，符合水肿或血脑屏障破坏。使用伽玛刀的立体定向放射外科手术不太可能消除由技术熟练且经验丰富的显微外科医生进行显微手术切除的必要性。然而，对于那些因医疗问题使手术具有不可接受的危险性的患者、患有双侧肿瘤或肿瘤位于其唯一有听力耳朵的患者、尽管手术切除后仍有复发性肿瘤的患者或拒绝显微手术切除的患者，放射外科手术是一种安全有效的治疗方法。
