Liu Dong, Xu Desheng, Zhang Zhiyuan, Zhang Yipei, Zheng Ligao
Gamma Knife Center, Department of Neurosurgery, Tianjin Medical University Second Hospital, Tianjin, Republic of China. tjliu@
J Neurosurg. 2006 Dec;105 Suppl:149-53. doi: 10.3171/sup.2006.105.7.149.
The authors sought to assess the results of Gamma Knife surgery (GKS) in patients with vestibular schwannomas (VSs).
Seventy-four consecutive patients (33 men and 41 women) were evaluated by means of serial imaging studies, clinical examinations, and questionnaires. Nineteen patients had undergone resection of their VS. Facial nerve function was normal in 63 patients (85.1%) before GKS, and 63.5% of them had useful hearing. The prescription peripheral dose varied between 10 and 14 Gy (mean 12.27 +/- 0.96 Gy); the corresponding central dose was 21 to 30 Gy (mean 24.9 +/- 2.18 Gy). The mean volume of the tumor at GKS was 10.79 +/- 5.52 ml (range 0.11-27.8 ml). A mean of eight isocenters (range 3-17) was used for treating these lesions. At a median follow-up period of 68.3 months (range 30-122 months), tumor shrinkage was observed in 60 patients (81.1%), and the tumor size was stable in 11 (14.8%). Persistent neuroimaging demonstrated evidence of progression in only three patients (4.1%): two underwent repeated GKS after an interval of 18 months and one continues to be observed. Five patients experienced trigeminal dysfunction: in three the dysfunction was transient and in the other two the dysfunction persists. Three patients suffered facial palsy. Useful hearing was preserved in 34 patients. Thirteen patients experienced some degree of hearing improvement. Deterioration of hearing was found in 13 of 62 patients who had Class I or II hearing before treatment.
Gamma Knife surgery prevents tumor growth; it achieves excellent neurological function preservation and produces few treatment-related complications.
作者试图评估伽玛刀手术（GKS）治疗前庭神经鞘瘤（VS）患者的效果。
通过系列影像学研究、临床检查和问卷调查对74例连续患者（33例男性和41例女性）进行评估。19例患者曾接受VS切除术。GKS术前63例患者（85.1%）面神经功能正常，其中63.5%患者有实用听力。处方周边剂量在10至14 Gy之间（平均12.27±0.96 Gy）；相应的中心剂量为21至30 Gy（平均(24.9\pm2.18) Gy）。GKS时肿瘤的平均体积为10.79±5.52 ml（范围0.11 - 27.8 ml）。平均使用8个等中心（范围3 - 17）治疗这些病变。中位随访期为68.3个月（范围30 - 122个月），60例患者（81.1%）观察到肿瘤缩小，11例（14.8%）肿瘤大小稳定。持续的神经影像学检查仅在3例患者（4.1%）中显示进展证据：2例在间隔18个月后接受了重复GKS，1例继续观察。5例患者出现三叉神经功能障碍：3例功能障碍为短暂性，另外2例功能障碍持续存在。3例患者发生面瘫。34例患者保留了实用听力。13例患者听力有一定程度改善。在治疗前听力为I级或II级的62例患者中，13例出现听力恶化。
伽玛刀手术可防止肿瘤生长；能实现出色的神经功能保留，且治疗相关并发症极少。
