Molina-Romero Oscar I, Segura-Hernandez Andrés, Fonnegra-Caballero Andrés, Diez-Palma Juan Carlos, Cortés-Muñoz Fabian, Fonnegra-Pardo Julio Roberto
Department of Neurosurgery, Fundación Clínica Shaio, Bogotá, Colombia.
Department of Research, Fundación Clínica Shaio, Bogotá, Colombia.
Surg Neurol Int. 2022 Dec 16;13:582. doi: 10.25259/SNI_679_2022. eCollection 2022.
Gamma Knife radiosurgery (GKR) is a technique that consists of the release of a high dose of ionizing radiation onto a therapeutic target, which has been previously delimited. This technique was described by Lars Leksell and Borje Larsson in 1951. In Colombia, there is only one GKR unit functioning machine nowadays. The objective of this study is to describe the institutional experience of a single institution with Gamma Knife Perfexion over 12 years.
We conducted a retrospective observational study. A total of 1906 medical records, taken from the period between May 4, 2010, and May 4, 2022, were included in the study. Descriptive analysis was performed through STATA 17 as statistic tool. Measures of central tendency were calculated depending on the distribution of the continuous data and proportions were taken into account in the case of qualitative variables.
A total of 1906 procedures were performed. Patients from 1 year to 99 years old were treated, with a median age of 51 years. The most frequent diagnoses were meningioma (20.8%), arteriovenous malformation (AVM) (17%), vestibular schwannoma (15.6%), metastases (9.81%), and trigeminal neuralgia (9.12%). At 3-year posttreatment, in meningiomas, tumor size stability was observed in 57.3%, size decrease in 36%, and disappearance in 1.3%. In AVM, complete obliteration of the lesion was described in 36.8% and a decrease in size in 52.6%. Intracranial hemorrhage occurred in 5.2% during the follow-up period and 3.5% of all treated patients required a new procedure due to residual malformation. In vestibular schwannomas, tumor size remained stable in 62.2% and decreased in 28.8%. No new cases of facial paralysis after the procedure were described. At 1-year posttreatment, in metastasis, the size of the lesions remained stable in 40% of the patients, decreased in 47.5%, and disappeared in 2.5%. In trigeminal neuralgia, 88.4% of patients had pain relief and recurrences occurred in 16.6%. Acute complications were generally uncommon, the main ones being headache, pain at frame fixation points, and nausea.
Our experience suggests that GKR is a noninvasive procedure with a broad spectrum of clinical applications, low frequency of complications, feasible, with good enough control size of tumor and vascular lesions in images, and good clinical results in the medium and long term.
伽玛刀放射外科治疗（GKR）是一种将高剂量电离辐射释放到预先划定的治疗靶点上的技术。该技术由拉尔斯·莱克塞尔（Lars Leksell）和博耶·拉尔森（Borje Larsson）于1951年描述。在哥伦比亚，目前仅有一台伽玛刀设备在运行。本研究的目的是描述一家机构在12年里使用伽玛刀Perfexion的机构经验。
我们进行了一项回顾性观察研究。该研究纳入了2010年5月4日至2022年5月4日期间的1906份医疗记录。使用STATA 17作为统计工具进行描述性分析。根据连续数据的分布计算集中趋势指标，对于定性变量则考虑比例。
共进行了1906例手术。治疗的患者年龄从1岁到99岁，中位年龄为51岁。最常见的诊断为脑膜瘤（20.8%）、动静脉畸形（AVM）（17%）、前庭神经鞘瘤（15.6%）、转移瘤（9.81%）和三叉神经痛（9.12%）。治疗后3年，在脑膜瘤患者中，57.3%的患者肿瘤大小稳定，36%的患者肿瘤大小减小，1.3%的患者肿瘤消失。在AVM患者中，36.8%的患者病变完全闭塞，52.6%的患者病变大小减小。随访期间颅内出血发生率为5.2%，所有接受治疗的患者中有3.5%因残留畸形需要再次手术。在前庭神经鞘瘤患者中，62.2%的患者肿瘤大小保持稳定，28.8%的患者肿瘤大小减小。术后未出现新的面瘫病例。治疗后1年，在转移瘤患者中，40%的患者病变大小保持稳定，47.5%的患者病变大小减小，2.5%的患者病变消失。在三叉神经痛患者中，88.4%的患者疼痛缓解，16.6%的患者复发。急性并发症一般不常见，主要包括头痛、框架固定点疼痛和恶心。
我们的经验表明，伽玛刀放射外科治疗是一种无创手术，临床应用广泛，并发症发生率低，可行，对肿瘤和血管病变在影像学上的大小控制良好，中长期临床效果良好。
