Department of Ophthalmology, National University Hospital, Singapore, Singapore.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Br J Ophthalmol. 2019 Oct;103(10):1453-1459. doi: 10.1136/bjophthalmol-2018-312893. Epub 2019 Jan 5.
To evaluate the efficacy and safety of multisession gamma knife radiosurgery (GKRS) for orbital apex venous cavernous malformation causing optic neuropathy.
Retrospective cohort study in a single tertiary institution from January 2007 to December 2016 on patients who underwent multisession GKRS for orbital apex venous cavernous malformations causing optic neuropathy.
There were 12 patients included in our study. The mean age was 40.2±14.5 years, and men comprised 66.7% (n=8). Decrease in visual acuity (83.3%) was the most common symptom at presentation. The mean clinical follow-up was 28.5 months. Ten (83.3%) of the 12 patients had improvement in best corrected visual acuity. Of the 10 patients with pre-existing relative afferent pupillary defect (RAPD), 6 (60%) had complete resolution of RAPD. Of the 12 patients with visual field defect, 7 (58.3%) had complete resolution, 3 (25%) had partial improvement, while 2 (16.7%) remained unchanged due to optic atrophy from long-standing compressive optic neuropathy. Mean proptosis reduced from 2.3±1.7 mm pre-GKRS to 0.5±1.3 mm post-GKRS (p=0.005). Tumour shrinkage was observed in all patients. The mean tumour volume at the time of GKRS was 3104 mm (range 221-8500 mm), which reduced to 658 mm (range 120-3350 mm) at last follow-up. None of the patients experienced GKRS-related ocular morbidity during the follow-up period.
Multisession GKRS has shown to be an effective and safe option for the treatment of orbital apex venous cavernous malformations causing optic neuropathy, with significant improvement in ophthalmic outcomes and reduction in tumour volume.
评估多疗程伽玛刀放射外科治疗引起视神经病变的眶尖静脉海绵状畸形的疗效和安全性。
对 2007 年 1 月至 2016 年 12 月在一家三级医院接受多疗程伽玛刀放射外科治疗的眶尖静脉海绵状畸形引起视神经病变的患者进行回顾性队列研究。
本研究共纳入 12 例患者，平均年龄为 40.2±14.5 岁，男性占 66.7%（n=8）。视力下降（83.3%）是最常见的首发症状。平均临床随访时间为 28.5 个月。12 例患者中有 10 例（83.3%）最佳矫正视力得到改善。在 10 例存在既往相对性传入性瞳孔障碍（RAPD）的患者中，6 例（60%）RAPD 完全缓解。在 12 例视野缺损患者中，7 例（58.3%）完全缓解，3 例（25%）部分改善，2 例（16.7%）因长期压迫性视神经病变导致视神经萎缩而无变化。平均眼球突出度从 GKRS 前的 2.3±1.7mm 减少到 GKRS 后的 0.5±1.3mm（p=0.005）。所有患者均观察到肿瘤缩小。GKRS 时肿瘤体积平均为 3104mm³（范围 221-8500mm³），末次随访时缩小至 658mm³（范围 120-3350mm³）。在随访期间，没有患者出现与 GKRS 相关的眼部并发症。
多疗程伽玛刀放射外科治疗引起视神经病变的眶尖静脉海绵状畸形是一种有效且安全的治疗选择，可显著改善眼部预后并缩小肿瘤体积。
