Tang Xuqun, Wu Hanfeng, Wang Binjiang, Zhang Nan, Dong YaFei, Ding Jianbo, Dai Jiazhong, Yu Tonggang, Pan Li
Department of Neurosurgery, Shanghai Gamma Hospital, Gamma Knife Centre of Huashan Hospital, Shanghai, 200235, China.
Acta Neurochir (Wien). 2015 Jun;157(6):961-9; discussion 969. doi: 10.1007/s00701-015-2417-5. Epub 2015 Apr 11.
Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients.
From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012 ) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25-76) years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.2 ± 8.2 cm(3) (range, 1-41 cm(3)). A mean marginal dose of 13.3 Gy (range, 8-15 Gy) was directed to the 49%-64% isodose line (mean 53%).
Of the 53 tumors, 6 (11%) were classified as intrasellar type. Eight (15%) were parasellar type and the other 39 cases(74%) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2-67 months) and 34 months (range, 2-73 months), respectively. The tumor control rate was 100%. The mean tumor volume reduction was 79.5% (range, 16.5%-100%) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2% tumor volume reduction (range, 16.5%-89.2%). Twenty-nine cases (55%) showed a >80% tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed.
Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment.
海绵窦血管瘤（CaSHs）是海绵窦（CS）中罕见的血管性病变。伽玛刀放射外科治疗（GKS）为显微手术提供了一种替代治疗方式。本研究旨在基于磁共振（MR）成像结果描述CaSHs的一种新分类，并确定GKS在大量CaSH患者中的疗效和安全性。
2007年4月至2012年11月，复旦大学附属华山医院伽玛刀中心使用Leksell伽玛刀C型（2012年4月之前）或Perfexion型（2012年5月起）治疗了53例患有CaSHs的患者。在这53例患者中，15例术后有明确的组织病理学诊断，38例根据其MR成像结果诊断。有15例男性和38例女性患者，平均年龄52岁（范围25 - 76岁）。CaSHs的MR图像特征是在T2加权和液体衰减反转恢复（FLAIR）图像上具有极高的均匀信号强度：与脑脊液信号一样亮。根据颈动脉线与肿瘤位置的关系，CaSHs分为三种类型：鞍内型、鞍旁型和混合型。肿瘤平均体积为13.2±8.2 cm³（范围1 - 41 cm³）。平均边缘剂量13.3 Gy（范围8 - 15 Gy）指向49% - 64%等剂量线（平均53%）。
53个肿瘤中，6个（11%）为鞍内型。8个（15%）为鞍旁型，其他39例（74%）为混合型。本研究的平均影像学和临床随访时间分别为24个月（范围2 - 67个月）和34个月（范围2 - 73个月）。肿瘤控制率为100%。与GKS治疗前相比，肿瘤平均体积缩小79.5%（范围16.5% - 100%）。GKS治疗6个月后，MR成像显示肿瘤平均体积缩小60.2%（范围16.5% - 89.2%）。29例（55%）肿瘤体积缩小>80%。在神经功能方面，这些患者中只有2例出现临床恶化，33例眼部或内分泌紊乱明显改善。在最后一次随访时，没有更多与GKS相关的并发症，且没有肿瘤进展。
我们的研究表明，GKS作为CaSHs的主要治疗方法和辅助治疗方法都是有用且安全的。CaSHs的新分类可能有助于预测其在肿瘤发展过程中的临床进程以及GKS治疗后的反应。需要进一步进行长期随访和更大样本量的研究，以优化治疗条件并验证这种治疗方法的益处。
