Tishler R B, Loeffler J S, Lunsford L D, Duma C, Alexander E, Kooy H M, Flickinger J C
Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA.
Int J Radiat Oncol Biol Phys. 1993 Sep 30;27(2):215-21. doi: 10.1016/0360-3016(93)90230-s.
Stereotactic radiosurgery is becoming a more accepted treatment option for benign, deep seated intracranial lesions. However, little is known about the effects of large single fractions of radiation on cranial nerves. This study was undertaken to assess the effect of radiosurgery on the cranial nerves of the cavernous sinus.
We examined the tolerance of cranial nerves (II-VI) following radiosurgery for 62 patients (42/62 with meningiomas) treated for lesions within or near the cavernous sinus. Twenty-nine patients were treated with a modified 6 MV linear accelerator (Joint Center for Radiation Therapy) and 33 were treated with the Gamma Knife (University of Pittsburgh). Three-dimensional treatment plans were retrospectively reviewed and maximum doses were calculated for the cavernous sinus and the optic nerve and chiasm.
Median follow-up was 19 months (range 3-49). New cranial neuropathies developed in 12 patients from 3-41 months following radiosurgery. Four of these complications involved injury to the optic system and 8 (3/8 transient) were the result of injury to the sensory or motor nerves of the cavernous sinus. There was no clear relationship between the maximum dose to the cavernous sinus and the development of complications for cranial nerves III-VI over the dose range used (1000-4000 cGy). For the optic apparatus, there was a significantly increased incidence of complications with dose. Four of 17 patients (24%) receiving greater than 800 cGy to any part of the optic apparatus developed visual complications compared with 0/35 who received less than 800 cGy (p = 0.009).
Radiosurgery using tumor-controlling doses of up to 4000 cGy appears to be a relatively safe technique in treating lesions within or near the sensory and motor nerves (III-VI) of the cavernous sinus. The dose to the optic apparatus should be limited to under 800 cGy.
立体定向放射外科正成为治疗良性深部颅内病变更被认可的治疗选择。然而，关于大剂量单次放疗对颅神经的影响知之甚少。本研究旨在评估放射外科对海绵窦颅神经的影响。
我们检查了62例接受放射外科治疗的患者（62例中有42例为脑膜瘤）海绵窦内或附近病变的颅神经（II - VI）耐受性。29例患者使用改良的6兆伏直线加速器（放射治疗联合中心）治疗，33例患者使用伽玛刀（匹兹堡大学）治疗。回顾性分析三维治疗计划，并计算海绵窦、视神经和视交叉的最大剂量。
中位随访时间为19个月（范围3 - 49个月）。12例患者在放射外科治疗后3至41个月出现新的颅神经病变。其中4例并发症涉及视神经系统损伤，8例（8例中有3例为短暂性）是海绵窦感觉或运动神经损伤的结果。在所用剂量范围（1000 - 4000厘戈瑞）内，海绵窦的最大剂量与颅神经III - VI并发症的发生之间没有明确关系。对于视器，并发症发生率随剂量显著增加。17例视器任何部位接受大于800厘戈瑞照射的患者中有4例（24%）出现视力并发症，而接受小于800厘戈瑞照射的35例患者中无一例出现（p = 0.009）。
使用高达4000厘戈瑞的肿瘤控制剂量进行放射外科治疗似乎是治疗海绵窦感觉和运动神经（III - VI）内或附近病变的相对安全技术。对视器的剂量应限制在800厘戈瑞以下。
