Kim In-Young, Kondziolka Douglas, Niranjan Ajay, Flickinger John C, Lunsford L Dade
Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
Acta Neurochir (Wien). 2009 May;151(5):447-52; discussion 452. doi: 10.1007/s00701-009-0273-x. Epub 2009 Apr 1.
Intraventricular meningiomas are relatively rare tumors that may benefit from stereotactic radiosurgery as a minimally invasive treatment strategy. We report our experience using gamma knife radiosurgery (GKR) for intraventricular meningiomas.
Over a 16-year period, we identified 9 patients with intraventricular meningiomas who were eligible for GKR out of a total management experience of 1,045 patients. The mean patient age was 51 years (range, 14 to 81). Three had radiosurgery for recurrent tumors after prior resection, and GKR was used as an adjunctive after subtotal resection in 1 patient. In the other 5 patients, GKR was used as primary management. Two had a diagnosis of meningioma confirmed by biopsy. The median tumor volume at GKR was 3.9 cc (range, 0.8-11.8). A median margin dose of 16.0 Gy (range, 14.0-22.5) was delivered to the tumor margin.
The average follow-up was 64 months. None of the patients developed hydrocephalus or treatment-related morbidity. The progression-free periods after radiosurgery varied from 7 to 160 months (mean, 60). Four tumors regressed and 2 remained unchanged. Three patients showed delayed tumor progression. Meningioma growth control was obtained in 7 out of 9 patients, but 1 patient required two radiosurgical procedures.
Gamma knife radiosurgery may be an additional minimally invasive management option for small intraventricular meningiomas in patients who either fail or are unsuitable for resection.
脑室内脑膜瘤是相对罕见的肿瘤，立体定向放射外科作为一种微创治疗策略可能对其有益。我们报告使用伽玛刀放射外科（GKR）治疗脑室内脑膜瘤的经验。
在16年期间，我们从1045例患者的总体治疗经验中确定了9例适合GKR治疗的脑室内脑膜瘤患者。患者平均年龄为51岁（范围14至81岁）。3例患者在先前切除术后因肿瘤复发接受放射外科治疗，1例患者在次全切除术后将GKR用作辅助治疗。在其他5例患者中，GKR用作主要治疗方法。2例经活检确诊为脑膜瘤。GKR治疗时肿瘤体积中位数为3.9 cc（范围0.8 - 11.8）。肿瘤边缘的中位边缘剂量为16.0 Gy（范围14.0 - 22.5）。
平均随访64个月。所有患者均未发生脑积水或与治疗相关的并发症。放射外科治疗后的无进展期从7个月至160个月不等（平均60个月）。4个肿瘤缩小，2个肿瘤保持不变。3例患者出现延迟性肿瘤进展。9例患者中有7例实现了脑膜瘤生长控制，但1例患者需要进行两次放射外科手术。
对于手术失败或不适合手术切除的小脑室内脑膜瘤患者，伽玛刀放射外科可能是一种额外的微创治疗选择。
