Dellaretti Marcos, Tagawa Eduardo K, Barbosa Pereira Julio Leonardo, Pedrini Mariana, Reis Baltazar Leão, de Sousa Atos Alves
Neurosurgery assistent at Santa Casa de Belo Horizonte and Faculdade de Ciências Medicas de Minais Gerais Belo Horizonte, MG, Brazil.
Department of Radiotherapy, Hospital Lifecenter, Belo Horizonte, Brazil.
J Radiosurg SBRT. 2011;1(2):169-172.
Malignant melanomas constitute 1-8% of all malignant tumors and are the third most common tumor to metastasize to the central nervous system. However, metastases to the cerebellopontine angle (CPA) are rare, accounting for only 0.2 to 0.7% of the lesions identified in this location A 62-year-old white man with a history of melanoma of the back, who had had all lesions completely excised, was reportedly tumor-free for 6 years. The patient presented bilateral metastatic CPA melanoma. Left side tumor was treated with surgery with partial resection (lost hearing) and radisorugery. Right side lesion was treated with radiosurgery and hearing preserved for 8 months, tumor controlled for 12 months, until death due to leptomeningeal carcinomatosis after 13 months of radiosurgey. The patient underwent intensity-modulated stereotactic radiosurgery using BrainLab Iplan 4.1 for both IAC lesions, the dose was 18Gy prescribed to the 80% isodose line delivered by 11 fields. The patient presented no post-radiosurgery neurological complications. In patients with lesions in the CPA, a diagnosis of melanoma should be included, particularly in cases with rapid progression of symptoms. Therefore, radiosurgery is a viable treatment option since the hearing can be preserved and tumor control achieved.
恶性黑色素瘤占所有恶性肿瘤的1%-8%，是第三大最常见的转移至中枢神经系统的肿瘤。然而，转移至桥小脑角（CPA）的情况罕见，仅占该部位确诊病变的0.2%至0.7%。一名62岁白人男性，有背部黑色素瘤病史，此前所有病变均已完全切除，据报道已无瘤生存6年。该患者出现双侧CPA转移性黑色素瘤。左侧肿瘤接受了部分切除手术（听力丧失）及放射外科手术治疗。右侧病变接受了放射外科手术治疗，听力保留了8个月，肿瘤控制了12个月，直到放射外科手术后13个月因软脑膜癌转移死亡。该患者针对两个内听道病变均使用BrainLab Iplan 4.1进行了调强立体定向放射外科治疗，剂量为18Gy，处方给11个野所形成的80%等剂量线。该患者放射外科手术后未出现神经并发症。对于CPA有病变的患者，应考虑黑色素瘤的诊断，尤其是症状迅速进展的病例。因此，放射外科是一种可行的治疗选择，因为它可以保留听力并实现肿瘤控制。
