Murovic Judith A, Gibbs Iris C, Chang Steven D, Mobley Bret C, Park Jon, Adler John R
Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA.
Neurosurgery. 2009 Feb;64(2 Suppl):A33-43. doi: 10.1227/01.NEU.0000341632.39692.9E.
To conduct a retrospective review of outcomes in 15 patients with 18 foraminal tumors, including 17 benign peripheral nerve sheath tumors and 1 malignant peripheral nerve sheath tumor, who underwent CyberKnife (Accuray, Inc., Sunnyvale, CA) radiosurgery at Stanford University Medical Center from 1999 to 2006.
Symptoms and findings, neurofibromatosis (NF) association, previous radiation, imaging, dosimetry, tumor volume, central necrosis, and the relation of these factors to outcomes were evaluated.
Before treatment, 1 asymptomatic patient had radiculopathic findings, 3 patients experienced local pain with intact neurological examinations, and 7 patients had radiculopathic complaints with intact (1 patient), radiculopathic (4 patients), or radiculomyelopathic examinations (2 patients). Five patients had myelopathic complaints and findings. Three patients had NF1-associated neurofibromas, 1 patient with NF2 had a schwannoma, and 1 patient had a schwannomatosis-related lesion. Two likely radiation-induced lesions, a neurofibroma and a malignant peripheral nerve sheath tumor, were observed. Prescribed doses ranging from 16 to 24 Gy, delivered in 1 to 3 fractions of 6 to 20 Gy, resulted in maximum tumor doses ranging from 20.9 to 30 Gy. Target volumes ranged from 1.36 to 16.9 mL. After radiosurgery, the asymptomatic case remained asymptomatic, and neurological findings improved. Thirteen of 15 symptomatic patients with (12 patients) or without (3 patients) neurological findings improved (3 cases after resection) or remained stable, and 2 patients worsened. Symptoms and examinations remained stable or improved in 8 (80%) of 10 patients with schwannomas and 3 (60%) of 5 patients with neurofibromas. Tumor volumes decreased in 12 (67%) of 18 tumors and increased in 3 tumors. Tumor volumes decreased in 8 of 10 schwannomas and 3 of 7 neurofibromas. Central necrosis developed in 8 (44%) of 18 tumors.
CyberKnife radiosurgery resulted in pain relief and functional preservation in selected foraminal peripheral nerve sheath tumors and a malignant peripheral nerve sheath tumor. Symptomatic and neurological improvements were more noticeable with schwannomas. Myelopathic symptoms may necessitate surgical debulking before radiosurgery.
对15例患有18个椎间孔肿瘤的患者的治疗结果进行回顾性分析，这些肿瘤包括17例良性周围神经鞘瘤和1例恶性周围神经鞘瘤，于1999年至2006年在斯坦福大学医学中心接受了射波刀（Accuray公司，加利福尼亚州桑尼维尔）放射外科治疗。
评估症状和检查结果、神经纤维瘤病（NF）关联、既往放疗情况、影像学、剂量测定、肿瘤体积、中央坏死以及这些因素与治疗结果的关系。
治疗前，1例无症状患者有神经根病表现，3例患者有局部疼痛但神经系统检查正常，7例患者有神经根病主诉且神经系统检查正常（1例）、神经根病（4例）或神经根脊髓病（2例）。5例患者有脊髓病主诉和表现。3例患者有与NF1相关的神经纤维瘤，1例NF2患者有神经鞘瘤，1例患者有与神经鞘瘤病相关的病变。观察到2例可能由放疗引起的病变，1例神经纤维瘤和1例恶性周围神经鞘瘤。处方剂量为16至24 Gy，分1至3次给予，每次6至20 Gy，最大肿瘤剂量为20.9至30 Gy。靶体积为1.36至16.9 mL。放射外科治疗后，无症状病例仍无症状，神经系统检查结果改善。15例有症状的患者中，13例（12例有神经系统检查结果，3例无）神经系统检查结果改善（3例切除后）或保持稳定，2例患者病情恶化。10例神经鞘瘤患者中有8例（80%）症状和检查保持稳定或改善，5例神经纤维瘤患者中有3例（60%）如此。18个肿瘤中有12个（67%）肿瘤体积缩小，3个肿瘤体积增大。10个神经鞘瘤中有8个、7个神经纤维瘤中有3个肿瘤体积缩小。18个肿瘤中有8个（44%）发生中央坏死。
射波刀放射外科治疗可使部分椎间孔周围神经鞘瘤和1例恶性周围神经鞘瘤患者缓解疼痛并保留功能。神经鞘瘤患者的症状和神经功能改善更为明显。脊髓病症状可能需要在放射外科治疗前进行手术减压。
