Lot G, Cophignon J
Service de neurochirurgie, Hôpital Lariboisière, Paris, France.
Cancer Radiother. 1998 Mar-Apr;2(2):223-7. doi: 10.1016/s1278-3218(98)89095-1.
Stereotactic radiosurgery, a term introduced by Leksell, was born more than 40 years ago, but has made great strides for the last 15 years. There is no consensus among neurosurgeons as to the best device (gamma knife, linear accelerator), the treatment doses, and the clinical indications of stereotactic radiosurgery. Therefore, this report is the viewpoint of one neurosurgical team only. In the radiosurgery literature, there is no clear evidence of better results with the gamma-knife or the linear accelerators. With regard to clinical applications, cerebral arteriovenous malformations are the more widely accepted indications of radiosurgery, since a cerebral angiography can confirm the disappearance of the nidus of an arteriovenous malformation treated by stereotactic radiosurgery. Usually, small and deep arteriovenous malformations can be treated by stereotactic radiosurgery only. Nevertheless, the treatment of the other arteriovenous malformations more often require procedures including one or several of the following treatment methods: microneurosurgery, interventional neuradiology, stereotactic radiosurgery. Stereotactic radiosurgery in acoustic schwannomas, skull base meningiomas, especially those involving the cavernous sinus, brain metastases, and pituitary tumors seem attractive. Contrary to arteriovenous malformations, the lack of criteria for cure requires a long follow-up and carefully controlled trials to confirm the efficiency of stereotactic radiosurgery for these tumors. On the other hand, experience of stereotactic radiosurgery for astrocytomas and glioblastomas is limited, and few publications are available. Furthermore, because of the infiltrating growth, a major impact of stereotactic radiosurgery for these tumors is presumably not to be expected. Lastly, a close multidisciplinary approach seems absolutely necessary to define the best indications of stereotactic radiosurgery and to improve its clinical results.
立体定向放射外科由莱克塞尔提出，诞生于40多年前，但在过去15年里取得了长足进展。神经外科医生对于最佳设备（伽马刀、直线加速器）、治疗剂量以及立体定向放射外科的临床适应症尚无共识。因此，本报告仅代表一个神经外科团队的观点。在放射外科文献中，尚无明确证据表明伽马刀或直线加速器能带来更好的治疗效果。就临床应用而言，脑动静脉畸形是放射外科应用更为广泛的适应症，因为脑血管造影可以证实经立体定向放射外科治疗的动静脉畸形病灶消失。通常，小型深部动静脉畸形仅可通过立体定向放射外科治疗。然而，其他动静脉畸形的治疗往往需要包括以下一种或几种治疗方法的联合治疗：显微神经外科手术、介入神经放射学、立体定向放射外科。立体定向放射外科在听神经瘤、颅底脑膜瘤，尤其是累及海绵窦的脑膜瘤、脑转移瘤和垂体瘤的治疗中似乎颇具吸引力。与动静脉畸形不同，由于缺乏治愈标准，对于这些肿瘤，需要长期随访和严格对照试验来证实立体定向放射外科的疗效。另一方面，立体定向放射外科治疗星形细胞瘤和胶质母细胞瘤的经验有限，相关出版物较少。此外，由于肿瘤呈浸润性生长，预计立体定向放射外科对这些肿瘤不会产生重大影响。最后，紧密的多学科协作对于明确立体定向放射外科的最佳适应症并改善其临床疗效似乎绝对必要。
