Wowra B, Horstmann G A, Cibis R, Czempiel H
Radiologe. 1997 Dec;37(12):1003-15. doi: 10.1007/s001170050314.
Gamma Knife radiosurgery (GKRS) was applied in 500 consecutive treatments for 445 patients within 2 years. Indications were arterio-venous malformations (93 patients), schwannomas of cranial nerves (75 patients), meningiomas (79 patients; 73 of the tumors involving the skull base), pituitary adenomas (40 patients), craniopharyngiomas (13 cases), gliomas (13 cases), rare indications (12 cases), and brain metastases (126 patients). In arterio-venous malformations two complications were observed whereas two other patients underwent surgery due to intracranial hemorrhage in the latent period after GKRS. In all cases follow-up with MRI showed evidence of an active obliteration process. Out of 24 patients with a follow-up over 1 year, angiography revealed complete obliteration in 9 patients so far. A partial obliteration was evidenced by MRI in 15 cases. In benign tumors (meningiomas and vestibular schwannomas) tumor control rates of 88% and 89% were achieved, respectively. Treatment related side effects were mild and rare; no facial palsy occured after primary Gamma Knife treatment. GKRS was particularly effective in inoperable skull base meningiomas. Cerebral metastases were controlled in 89.5% by a single Gamma Knife treatment. The mean survival period was 11.8 months. In patients receiving a single Gamma Knife treatment the mean survival time was 9.1 months. For patients undergoing multiple (up to 5) sessions of GKRS (because of new tumors) the mean survival period was 17.2 months. MRI showed evidence of adverse radiation reactions in 10/124 patients (8.1%) which were symptomatic in 3 patients (0.8%). The results obtained in patients with cerebral metastases emphasize that GKRS alone is as effective as the combined treatment of these lesions by surgery and fractionated radiotherapy. Our results demonstrated an attractively high therapeutic gain factor of Gamma Knife treatment in key indications of radiosurgery.
在两年内，对445例患者连续进行了500次伽玛刀放射外科治疗（GKRS）。治疗适应症包括动静脉畸形（93例患者）、颅神经鞘瘤（75例患者）、脑膜瘤（79例患者；其中73例肿瘤累及颅底）、垂体腺瘤（40例患者）、颅咽管瘤（13例）、胶质瘤（13例）、罕见适应症（12例）以及脑转移瘤（126例患者）。在动静脉畸形患者中，观察到两例并发症，另有两名患者在GKRS后的潜伏期内因颅内出血接受了手术。在所有病例中，MRI随访显示有明显的闭塞过程。在24例随访超过1年的患者中，血管造影显示目前有9例完全闭塞。MRI证实15例有部分闭塞。在良性肿瘤（脑膜瘤和前庭神经鞘瘤）中，肿瘤控制率分别达到88%和89%。与治疗相关的副作用轻微且罕见；初次伽玛刀治疗后未发生面瘫。GKRS对无法手术的颅底脑膜瘤特别有效。单次伽玛刀治疗可使89.5%的脑转移瘤得到控制。平均生存期为11.8个月。接受单次伽玛刀治疗的患者平均生存时间为9.1个月。对于因出现新肿瘤而接受多次（最多5次）GKRS治疗的患者，平均生存期为17.2个月。MRI显示10/124例患者（8.1%）有放射性不良反应，其中3例有症状（0.8%）。脑转移瘤患者的治疗结果表明，单独使用GKRS与手术和分次放疗联合治疗这些病变的效果相同。我们的结果显示，在放射外科的关键适应症中，伽玛刀治疗具有极具吸引力的高治疗增益因子。
