原发性立体定向放射外科治疗症状性颅底脑膜瘤后的颅神经结局。
Cranial nerve outcomes after primary stereotactic radiosurgery for symptomatic skull base meningiomas.
机构信息
Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh, Suit B-400, UPMC Presbyterian, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
出版信息
J Neurooncol. 2018 Sep;139(2):341-348. doi: 10.1007/s11060-018-2866-9. Epub 2018 Apr 24.
OBJECTIVE
To evaluate cranial nerve (CN) outcomes after primary stereotactic radiosurgery (SRS) for petroclival, cavernous sinus, and cerebellopontine angle meningiomas.
METHODS
From our prospectively maintained database of 2022 meningioma patients who underwent Leksell stereotactic radiosurgery (SRS) during a 30-year interval, we found 98 patients with petroclival, 242 with cavernous sinus, and 55 patients with cerebellopontine angle meningiomas. Primary radiosurgery was performed in 245 patients. Patients included in this report had at least one CN deficit at the time of initial presentation and a minimum of 12 month follow up. Median age at the time of SRS was 58 years. Median follow up was 58 months (range 12-300 months), Median tumor volume treated with SRS was 5.9 cm (range 0.5-37.5 cm), and median margin dose was 13 Gy (range 9-20Gy).
RESULTS
Tumor control was achieved in 229 patients (93.5%) at a median follow up of 58 months. Progression free survival rate (PFS) after SRS was 98.7% at 1 year, 96.4% at 3 years, 93.7% at 5 years, and 86.4% at 10 years Overall, 114 of the 245 patients (46.5%) reported improvement of CN function. Patients with CP angle meningiomas demonstrated lower rates of CN improvement compared to petroclival and cavernous sinus meningioma patients. Deterioration of CN function after SRS developed in 24 patients (10%). The rate of deterioration was 2.8% at 1 year, 5.2% at 3 years, and 8% at 10 years.
CONCLUSION
Primary SRS provides effective tumor control and favorable rate of improvement of preexisting CN deficit.
目的
评估原发性立体定向放射外科（SRS）治疗岩斜区、海绵窦和桥小脑角脑膜瘤后颅神经（CN）的预后。
方法
从我们前瞻性维护的 2022 例脑膜瘤患者数据库中，我们发现了 98 例岩斜区、242 例海绵窦和 55 例桥小脑角脑膜瘤患者。在 30 年的时间间隔内，对这些患者进行了 Leksell 立体定向放射外科治疗（SRS）。本报告中纳入的患者在初始表现时至少有 1 种 CN 缺陷，且随访时间至少为 12 个月。SRS 时的中位年龄为 58 岁。中位随访时间为 58 个月（范围 12-300 个月），中位 SRS 治疗肿瘤体积为 5.9cm（范围 0.5-37.5cm），中位边缘剂量为 13Gy（范围 9-20Gy）。
结果
在中位随访 58 个月时，229 例（93.5%）患者肿瘤得到控制。SRS 后无进展生存率（PFS）为 1 年时 98.7%，3 年时 96.4%，5 年时 93.7%，10 年时 86.4%。总体而言，245 例患者中有 114 例（46.5%）报告 CN 功能改善。与岩斜区和海绵窦脑膜瘤患者相比，CP 角脑膜瘤患者 CN 改善率较低。24 例（10%）患者 SRS 后 CN 功能恶化。恶化率在 1 年内为 2.8%，3 年内为 5.2%，10 年内为 8%。
结论
原发性 SRS 可有效控制肿瘤，提高原发性 CN 缺陷的改善率。
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