Department of Neurological Surgery, University of Pittsburgh, Pennsylvania 15213, USA.
J Neurosurg. 2010 May;112(5):957-64. doi: 10.3171/2009.8.JNS09695.
Because of their critical location adjacent to brain, cranial nerve, and vascular structures, petroclival meningiomas remain a clinical challenge. The authors evaluated outcomes in 168 patients with petroclival meningiomas who underwent Gamma Knife surgery (GKS) during a 21-year interval.
Gamma Knife surgery was used as either primary or adjuvant treatment of 168 petroclival meningiomas involving the region between the petrous apex and the upper two-thirds of the clivus. The most common presenting symptoms were trigeminal nerve dysfunction, balance problems, diplopia, and hearing loss. The median tumor volume was 6.1 cm3 (range 0.3-32.5 cm3), and the median radiation dose to the tumor margin was 13 Gy (range 9-18 Gy).
During a median follow-up of 72 months, neurological status improved in 44 patients (26%), remained stable in 98 (58%), and worsened in 26 (15%). Tumor volume decreased in 78 patients (46%), remained stable in 74 (44%), and increased in 16 (10%), all of whom were subjected to additional management strategies. Overall 5- and 10-year progression-free survival rates were 91 and 86%, respectively. Patients followed up for at least 10 years (31 patients) had tumor and symptom control rates of 97 and 94%, respectively. Eight patients had repeat radiosurgery, 4 underwent delayed resection, and 4 had fractionated radiation therapy. Cerebrospinal fluid diversion was performed in 7 patients (4%). Significant risk factors for tumor progression were a tumor volume > or = 8 cm3 (p = 0.001) and male sex (p = 0.02).
In this 21-year experience, GKS for petroclival meningiomas obviated initial or further resection in 98% of patients and was associated with a low risk of adverse radiation effects. The authors believe that radiosurgery should be considered as an initial option for patients with smaller-volume, symptomatic petroclival meningiomas.
由于毗邻颅脑、颅神经和血管结构，岩斜脑膜瘤仍然是临床治疗的挑战。作者评估了 21 年间接受伽玛刀手术（GKS）治疗的 168 例岩斜脑膜瘤患者的治疗结果。
GKS 用于 168 例岩斜脑膜瘤患者的初始或辅助治疗，这些患者的肿瘤累及岩骨尖和斜坡上 2/3 之间的区域。最常见的表现症状为三叉神经功能障碍、平衡问题、复视和听力丧失。肿瘤体积中位数为 6.1cm³（范围 0.3-32.5cm³），肿瘤边缘的中位放射剂量为 13Gy（范围 9-18Gy）。
中位随访 72 个月时，44 例（26%）患者神经功能状态改善，98 例（58%）患者保持稳定，26 例（15%）患者恶化。78 例（46%）患者肿瘤体积缩小，74 例（44%）患者肿瘤体积保持稳定，16 例（10%）患者肿瘤体积增大，所有这些患者均接受了额外的治疗策略。总的 5 年和 10 年无进展生存率分别为 91%和 86%。至少随访 10 年的 31 例患者肿瘤和症状控制率分别为 97%和 94%。8 例患者行重复伽玛刀治疗，4 例行延迟切除术，4 例行分次放射治疗。7 例（4%）患者行脑脊液分流术。肿瘤进展的显著危险因素是肿瘤体积≥8cm³（p=0.001）和男性（p=0.02）。
在这项 21 年的经验中，GKS 治疗岩斜脑膜瘤使 98%的患者避免了初始或进一步的切除术，且不良反应风险低。作者认为，对于较小体积、有症状的岩斜脑膜瘤患者，放射外科治疗应作为初始选择。
