Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Department of Neurosurgery, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Neurosurgery Office, Fifth Floor, Chandigarh, 160012, India.
Neurosurg Rev. 2020 Feb;43(1):27-40. doi: 10.1007/s10143-018-0975-8. Epub 2018 Apr 9.
Gamma knife radiosurgery (GKRS) has emerged as a suitable primary treatment option for confined cavernous sinus tumors (CSTs) and residual/recurrent benign tumors extending from the surrounding neighborhood. The aim of this review was to further investigate the safety and efficacy of single-fraction GKRS for primary confined CSTs (hemangioma, meningioma, and schwannoma). This was a retrospective analysis of 16 patients of CSTs, primarily treated with GKRS between 2009 and 2017. The patients underwent follow-up clinical and radiological evaluation at a regular interval. Data on clinical and imaging parameters were analyzed. The published literature on GKRS for CSTs was reviewed. There were total 16 patients (eight meningiomas, seven hemangiomas, and one schwannoma). Patients presented with a headache (56.3%), ptosis (50%), and/or restricted extraocular movements (50%). There was 46.6% tumor volume (TV) reduction after single-fraction GKRS. Hemangiomas showed best TV reduction (64% reduction at > 3-year follow-up) followed by schwannoma (41.5%) and meningioma (25.4%). 56.3% of patients developed transient hypoesthesia in trigeminal nerve distribution. 44.4% of patients became completely pain-free. Among cranial nerves, the superior division of the oculomotor nerve showed best outcome (ptosis 62.5%) followed by an improved range of EOM. There was no adverse event in the form of new-onset deficit, vascular complication, or malignant transformation except for one out of the field failures. Among available treatment options, GKRS is the most suitable option by virtue of its minimally invasive nature, optimal long-term tumor control, improvement in cranial neuropathies, cost-effectiveness, favorable risk-benefit ratio, and minimal long-term complications.
伽玛刀放射外科 (GKRS) 已成为治疗局限于海绵窦的肿瘤 (CSTs) 和由周围组织延伸而来的残留/复发性良性肿瘤的合适的一线治疗选择。本研究旨在进一步探讨单次 GKRS 治疗原发性局限型 CSTs(血管瘤、脑膜瘤和神经鞘瘤)的安全性和有效性。这是对 2009 年至 2017 年间接受 GKRS 主要治疗的 16 例 CST 患者的回顾性分析。患者在定期间隔接受临床和影像学随访评估。分析了临床和影像学参数的数据。回顾了 GKRS 治疗 CST 的相关文献。共有 16 例患者(8 例脑膜瘤、7 例血管瘤和 1 例神经鞘瘤)。患者表现为头痛(56.3%)、上睑下垂(50%)和/或眼外肌运动受限(50%)。单次 GKRS 治疗后肿瘤体积(TV)减少了 46.6%。血管瘤显示出最佳的 TV 减少(>3 年随访时减少 64%),其次是神经鞘瘤(41.5%)和脑膜瘤(25.4%)。56.3%的患者三叉神经分布区出现短暂的感觉减退。44.4%的患者完全无痛。在颅神经中,动眼神经上支的结果最好(上睑下垂 62.5%),其次是眼外肌运动范围的改善。除 1 例野外失败外,无新发缺陷、血管并发症或恶性转化等不良事件。在现有的治疗选择中,GKRS 因其微创性、最佳的长期肿瘤控制、改善颅神经病变、成本效益、有利的风险效益比和最小的长期并发症,是最适合的选择。