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目的 :评价颅内囊性肿瘤经立体定向抽液前后容积变化在伽玛刀治疗中的作用。方法 :对 39例颅内囊性肿瘤 MRI定位后 ,确定穿刺道和靶点坐标 ,采用立体定向技术抽吸瘤内囊液使肿瘤容积缩小 ,然后二次 MRI定位行伽玛刀治疗。边缘剂量为 10～ 2 5 Gy,平均 15 .17Gy。确定 3%风险概率为警戒线 ,应用 L ogistic综合方程(Neuret)分析剂量 -容积关系和应用平均剂量 15 Gy的容积 -风险概率的相关性。将抽囊液前后容积和风险概率变化进行配对 t检验 ,P<0 .0 5具有统计学显著性。结果 :(1)立体定向抽液后肿瘤容积显著减少 ,抽液前为 4.10～72 .90 ml,平均 2 5 .5 5 ml;抽液后为 1.70～ 6 3.5 0 m l,平均 11.40 m l,P<0 .0 1,脑坏死风险概率显著降低 ,抽液前为0 .0 3%～ 2 8.2 7% ,平均 9.48% ;抽液后为 0 .0 1%～ 15 .40 % ,平均 3.86 % ,P<0 .0 0 1。 (2 )以 3%风险概率作为警戒线的剂量 -容积效应关系显示 ,在容积 <4.5 ml时 ,允许剂量在 17～ 2 0 Gy,容积在 4.6～ 10 ml时 ,剂量为 14～ 17Gy,容积超过 10 m l时 ,允许的剂量应 <14Gy;在给予平均剂量 15 Gy治疗肿瘤的容积—风险概率呈正相关 ,回归方程为 f(X) =0 .0 0 42 x+0 .0 0 0 7。结论 :颅内囊性肿瘤的容积在伽玛刀治疗中非常重要 ,立体定向术抽液术是缩小?
OBJECTIVE: To evaluate the role of volume changes in intracranial cystic tumors before and after stereotactic pumping. Methods: Thirty-nine cases of intracranial cystic tumor were located by MRI, the punctures and target coordinates were determined, and the volume of tumor was reduced by using stereotactic technique to suction tumor cyst fluid. Then the second MRI was performed with gamma knife. Edge dose of 10 ~ 25 Gy, an average of 15.17Gy. The 3% probability of risk was defined as a warning line, and the correlation between dose-volume relationship and volume-risk probability of 15 Gy with mean dose was analyzed using the L ogistic equation (Neuret). Paired t-test was used to compare the changes of volume and risk probability before and after operation, P <0.05 was considered statistically significant. Results: (1) After stereotactic drainage, the tumor volume decreased significantly from 4.10 to 72.90 ml, with an average of 25.55 ml and from 1.70 to 6.350 ml after liquid pumping, with an average of 11.40 ml, P <0 .0 1, the risk of brain necrosis significantly reduced, before the fluid was 0.30% ~ 2 8.27%, an average of 9.48%; after pumping fluid was 0.1% ~ 15.40%, an average of 3.86% , P <0. 0 0 1. (2) The dose-volume effect relationship with a 3% risk probability as a warning line shows that when the volume is less than 4.5 ml, the allowable dose is 17-20 Gy and the volume is 4.6-10 ml, the dose is 14-17Gy. The volume Permissible doses should be <14 Gy at surpassed 10 ml; volume-risk probability at 15 Gy treated with mean dose was positively correlated with regression equation f (X) = 0.042 x +0.0707. Conclusion: The volume of intracranial cystic tumors is very important in the treatment of gamma knife. Stereotactic drainage is shrinking?