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目的回顾性分析伽玛刀(γ刀)对大型三叉神经鞘瘤的治疗效果。方法应用Leksellγ刀治疗大型三叉神经鞘瘤30例,肿瘤最大径为31.0～53.0mm。照射肿瘤的平均中心剂量为25.8Gy,平均周边剂量12.2Gy。平均随访时间78个月(24～136个月)。结果症状改善24例,无变化3例,加重2例,死亡1例。肿瘤变化4例肿瘤基本消失,20例明显缩小,3例未增大,3例增大(1例死亡,2例再手术),肿瘤的控制率为90%。γ刀术后30个月再手术患者的病理结果大部分肿瘤组织坏死,残存肿瘤细胞透明变性,核固缩、核异形。结论γ刀对选择性大型三叉神经鞘瘤(最大径≤40mm)有良好的中长期控制作用。
Objective To retrospectively analyze the therapeutic effect of gamma knife (Gamma Knife) on large trigeminal schwannoma. Methods Thirty patients with large trigeminal schwannoma were treated with Leksellγ knife. The maximum diameter of tumor was 31.0-53.0 mm. The average center dose for tumor irradiation was 25.8 Gy and the average peripheral dose was 12.2 Gy. The average follow-up time was 78 months (24 to 136 months). Results The symptoms improved in 24 cases, no change in 3 cases, exacerbation in 2 cases, and death in 1 case. Tumor changes in 4 cases disappeared, 20 cases significantly reduced, 3 cases did not increase, 3 cases increased (1 died, 2 cases of reoperation), the tumor control rate was 90%. Gamma knife surgery 30 months after re-operation in patients with pathological findings most of the tumor necrosis, residual tumor cells transparent degeneration, nuclear pyknosis, nuclear heterotrophic. Conclusion Gamma knife has good long-term and long-term control effect on large, selective trigeminal schwannoma (maximal diameter ≤40mm).