Linskey M E, Lunsford L D, Flickinger J C
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Neurosurgery. 1990 May;26(5):736-44; discussion 744-5. doi: 10.1097/00006123-199005000-00002.
We reviewed our early experience with the first 26 patients with acoustic neurinomas (21 unilateral, 5 bilateral) treated by stereotactic radiosurgery using the first North American 201-source cobalt-60 gamma knife. Follow-up ranged from 6 to 19 months (median, 13 months). Serial postoperative imaging showed either a decrease in tumor size (11 patients) or growth arrest (15 patients). Loss of central contrast enhancement was a characteristic change (18 patients). Seven patients had good or serviceable hearing preoperatively. In all 7 the preoperative hearing status was retained immediately after radiosurgery. At follow-up, 3 had preserved hearing, 1 had reduced hearing, and 3 had lost all hearing in the treated ear. Hearing in 1 patient that was nonserviceable preoperatively later improved to a serviceable hearing level. Delayed facial paresis developed in 6 patients, and delayed trigeminal sensory loss developed in 7 patients, none of whom had significant deficits before radiosurgery. Both facial and trigeminal deficits tended to improve within 3 to 6 months of onset with excellent recovery anticipated. Lower cranial nerve dysfunction was not observed. All 26 patients remain at their preoperative employment or functional status. At present, stereotactic radiosurgery is an alternative treatment for acoustic neurinomas in patients who are elderly, have significant concomitant medical problems, have a tumor in their only hearing ear, have bilateral acoustic neurinomas, refuse microsurgical excision, or have recurrent tumor despite surgical resection. Although longer and more extensive follow-up is required, the control of tumor growth and the acceptable rate of complications in this early experience testifies to the future expanding role of this technique in the management of selected acoustic neurinomas.
我们回顾了使用北美第一台201源钴-60伽玛刀对最初26例听神经瘤患者（21例单侧，5例双侧）进行立体定向放射外科治疗的早期经验。随访时间为6至19个月（中位数为13个月）。术后系列影像学检查显示肿瘤大小减小（11例患者）或生长停滞（15例患者）。中心对比增强消失是其特征性变化（18例患者）。7例患者术前听力良好或尚可。放射外科治疗后，所有7例患者立即保留了术前听力状态。随访时，3例患者听力得以保留，1例患者听力下降，3例患者患耳听力完全丧失。1例术前听力不可用的患者后来听力改善到可用水平。6例患者出现迟发性面神经麻痹，7例患者出现迟发性三叉神经感觉丧失，这些患者在放射外科治疗前均无明显功能缺损。面神经和三叉神经功能缺损在发病后3至6个月内均有改善趋势，预期恢复良好。未观察到下颅神经功能障碍。所有26例患者仍保持术前的工作状态或功能状态。目前，立体定向放射外科是老年患者、有严重合并症、唯一有听力的耳朵患有肿瘤、双侧听神经瘤、拒绝显微手术切除或尽管手术切除仍有复发性肿瘤的听神经瘤患者的一种替代治疗方法。尽管需要更长时间和更广泛的随访，但在这一早期经验中，肿瘤生长的控制和可接受的并发症发生率证明了该技术在选定听神经瘤治疗中未来不断扩大的作用。
