Liscák R, Vladyka V, Simonová G, Novotný J
Oddĕlení stereotaktické a radiacní neurochirurgie, Nemocnice Na Homolce, Praha.
Cas Lek Cesk. 1995 Sep 6;134(17):534-8.
Up to the present time radical microsurgery of the tumour was considered the most satisfactory treatment. Now an ever more important part in the treatment of these tumours is played by radiosurgery. It involves minimal surgical stress, a minimal rate of complications and minimal change of lifestyle during the postoperative period. The objective of the submitted work was to evaluate the authors' results with the use of Leksell's gamma knife.
In 1992-1994 48 patients with meningiomas were indicated for treatment with a gamma knife. The group comprised 12 men (25%) and 36 women (75%) aged 18-73 years (mean age 52.8 years which did not differ significantly in the two groups). In 19 patients (39.6%) one or more neurosurgical operations were carried out previously, in 4 patients (8.3%) fractionated radiotherapy. Karnofski's score, as an indicator of the general condition, varied between 30-90%, the mean value for the whole group being 71%. The calculated volume of the meningioma was between 0.7 and 25.8 cm3, the average being 7.4 cm3. Collateral oedema in the adjacent area of the tumour was found in 6 patients (12.5%). In 19 patients (39.6%) the tumour was at the base of the skull, in 29 patients (60.4%) at other sites. The radiosurgically administered dose was within the range of 6.5-24 Gy, on average 14,2 Gy, on the isodose on average 50.7% (range 40-75%). The dose below the maximum was within the range of 13-45 Gy), on average 28.3 Gy. Only in two patients fractionated administration of the dose was used. After a 6-month interval following operation 30 patients were examined. In 7 patients (23.3%) partial wrinkling of the meningioma occurred (range 6-18 months), Karnofski's score improved by 10% in 8 (26.6%) and deteriorated in 3 patients (10%). The neurodeficit improved in 7 (23.3%) and deteriorated in 4 patients (13.3%). Collateral oedema developed in 5 patients (16.6%) 5-7 months after operation, in about half the patients it was symptom free. During the follow up period 2 patients died (8 and 5 months following surgery): in one the cause of death was not associated with the basic disease, in the second patient (where radiotherapy was the third neurosurgical operation) the radiosurgical operation could not reverse tha fatal course of the disease.
Radiosurgery of meningiomas is a safe therapeutic method with zero mortality, minimal surgical stress, a minimal rate of complications and a minimal morbidity. It is indicated in meningiomas and possibly their residues after subtotal neurosurgery up to a maximal volume of 30 cm3. It is primary treatment suitable in particular in old.patients, patients with a high per- and postoperative risk and in patients refusing open neurosurgery.
直到目前，肿瘤根治性显微手术一直被认为是最令人满意的治疗方法。如今，放射外科在这些肿瘤的治疗中发挥着越来越重要的作用。它涉及的手术应激极小、并发症发生率极低，且术后生活方式改变极小。本研究的目的是评估作者使用Leksell伽玛刀的治疗效果。
1992年至1994年，48例脑膜瘤患者接受了伽玛刀治疗。该组包括12名男性（25%）和36名女性（75%），年龄在18至73岁之间（平均年龄52.8岁，两组间无显著差异）。19例患者（39.6%）之前接受过一次或多次神经外科手术，4例患者（8.3%）接受过分次放疗。作为总体状况指标的卡诺夫斯基评分在30%至90%之间，全组平均值为71%。计算得出的脑膜瘤体积在0.7至25.8立方厘米之间，平均为7.4立方厘米。6例患者（12.5%）在肿瘤相邻区域发现有继发性水肿。19例患者（39.6%）的肿瘤位于颅底，29例患者（60.4%）的肿瘤位于其他部位。放射外科给予的剂量在6.5至24 Gy范围内，平均为14.2 Gy，等剂量线上平均为50.7%（范围为40%至75%）。最大剂量以下的剂量在13至45 Gy范围内，平均为28.3 Gy。仅2例患者采用了分次给药。术后6个月时对30例患者进行了检查。7例患者（23.3%）出现脑膜瘤部分皱缩（时间范围为6至18个月），8例患者（26.6%）的卡诺夫斯基评分提高了10%，3例患者（10%）的评分恶化。7例患者（23.3%）的神经功能缺损得到改善，4例患者（13.3%）的神经功能缺损恶化。5例患者（16.6%）在术后5至7个月出现继发性水肿，约一半患者无症状。在随访期间，2例患者死亡（术后8个月和5个月）：1例患者的死亡原因与基础疾病无关，另1例患者（放疗是第三次神经外科手术）放射外科手术未能逆转疾病的致命进程。
脑膜瘤的放射外科是一种安全的治疗方法，死亡率为零，手术应激极小，并发症发生率极低，发病率也极低。适用于脑膜瘤及其在神经外科次全切除术后的残留，最大体积可达30立方厘米。它是一种主要的治疗方法，特别适用于老年患者、围手术期和术后风险高的患者以及拒绝开放性神经外科手术的患者。
