伽玛刀立体定向放射外科治疗非前庭颅神经鞘瘤
Gamma Knife Stereotactic Radiosurgery for Nonvestibular Cranial Nerve Schwannomas.
作者信息
Langlois Anne-Marie, Iorio-Morin Christian, Masson-Côté Laurence, Mathieu David
机构信息
Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
Department of Radiation-Oncology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
出版信息
World Neurosurg. 2018 Feb;110:e1031-e1039. doi: 10.1016/j.wneu.2017.11.163. Epub 2017 Dec 6.
BACKGROUND
Nonvestibular cranial schwannomas represent a rare type of benign intracranial tumor. Few studies have evaluated the use of stereotactic radiosurgery (SRS) as a primary management option for these lesions. We performed a retrospective review of our institution's experience focusing on efficacy with regard to tumor control and clinical symptom stabilization as well as treatment safety.
METHODS
Patients were included if they underwent at least 1 SRS procedure for a nonvestibular schwannoma and had at least 6 months of available imaging follow-up. Demographic, SRS dose planning, clinical, and imaging data were collected from chart reviews of treated patients. χ and Kaplan-Meier analyses were performed.
RESULTS
Between 2004 and 2016, 35 schwannomas were treated in 34 patients. Median follow-up was 48 months. Median age at time of treatment was 51 years. Three patients had neurofibromatosis 2. Schwannoma location was trigeminal (57%), facial (20%), jugular foramen (14%), abducens (6%), and trochlear (3%). Median margin dose delivered was 13 Gy. The 5-year and 10-year tumor control rates were 94.4% and 88.5%, respectively. Presenting clinical symptoms stabilized or improved in 79% of cases after radiosurgery, and new or worsening symptoms were seen in 21%.
CONCLUSIONS
SRS is a safe and effective modality for treatment of nonvestibular cranial nerve schwannomas.
背景
非前庭神经鞘瘤是一种罕见的颅内良性肿瘤。很少有研究评估立体定向放射外科（SRS）作为这些病变的主要治疗选择的应用情况。我们对本机构的经验进行了回顾性分析，重点关注肿瘤控制、临床症状稳定方面的疗效以及治疗安全性。
方法
纳入标准为接受过至少一次SRS治疗非前庭神经鞘瘤且有至少6个月可用影像随访资料的患者。从治疗患者的病历回顾中收集人口统计学、SRS剂量规划、临床和影像数据。进行χ检验和Kaplan-Meier分析。
结果
2004年至2016年期间，34例患者共治疗了35个神经鞘瘤。中位随访时间为48个月。治疗时的中位年龄为51岁。3例患者患有神经纤维瘤病2型。神经鞘瘤位置为三叉神经（57%）、面神经（20%）、颈静脉孔（14%）、展神经（6%）和滑车神经（3%）。中位边缘剂量为13 Gy。5年和10年的肿瘤控制率分别为94.4%和88.5%。放射外科治疗后，79%的病例现有临床症状稳定或改善，21%出现新的或加重的症状。
结论
SRS是治疗非前庭颅神经鞘瘤的一种安全有效的方法。
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