伽玛刀放射外科治疗内听道内神经鞘瘤。
Gamma knife radiosurgery for intralabyrinthine schwannomas.
作者信息
Massager Nicolas, Drogba Landry, Delbrouck Carine, Benmebarek Nadir, Desmedt Françoise, Devriendt Daniel
机构信息
Gamma Knife Center, Erasme University Hospital, Brussels, Belgium.
Clinic of Stereotactic and Functional Neurosurgery, Erasme University Hospital, Brussels, Belgium.
出版信息
J Radiosurg SBRT. 2011;1(3):237-245.
OBJECT
To analyze indications and technical specificities of treatment of intralabyrinthine schwannoma (ILS) by Gamma Knife radiosurgery.
METHODS
Six patients were treated by Gamma Knife irradiation for a schwannoma arising from the cochleo-vestibular structures. Patients presented hearing worsening at different stages, tinnitus, imbalance and/or vertigo.
RESULTS
ILS was intravestibular/intracochlear/intravestibulocochlear/ transmacular in respectively 2/1/2/1 patients. We cover the entire tumor volume with a margin prescription dose of 12-Gy. The tumor volume remained unchanged at last follow-up in all cases; for 4 patients with functional hearing still present before treatment, the audiological status remained stable in 2 patients, worsened moderately in 1 patientand worsened to cophosis in 1 patient. No patient experienced worsening of tinnitus, imbalance or vertigo after irradiation.
CONCLUSIONS
Gamma Knife treatment of ILS is technically feasible without risk thanks to the precision of current robotized Gamma Knife devices. Patients treated radiosurgically avoid some of the risks of microsurgery, could in some cases maintain useful hearing and prevent further symptoms worsening.
目的
分析伽玛刀放射外科治疗迷路内神经鞘瘤（ILS）的适应证及技术特点。
方法
6例因耳蜗 - 前庭结构神经鞘瘤接受伽玛刀照射治疗的患者。患者在不同阶段出现听力下降、耳鸣、平衡失调和/或眩晕。
结果
ILS分别位于前庭内/耳蜗内/前庭耳蜗内/穿黄斑部，各有2/1/2/1例患者。我们用12 Gy的边缘处方剂量覆盖整个肿瘤体积。在最后一次随访时，所有病例的肿瘤体积均保持不变；对于4例治疗前仍有功能性听力的患者，2例患者的听力状况保持稳定，1例患者中度恶化，1例患者恶化为全聋。照射后无患者出现耳鸣、平衡失调或眩晕加重。
结论
由于当前自动化伽玛刀设备的精确性，伽玛刀治疗ILS在技术上是可行且无风险的。接受放射外科治疗的患者可避免一些显微手术的风险，在某些情况下可保持有用听力并防止症状进一步恶化。
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