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目的 评估立体定向放射 (γ刀 )治疗脑内海绵状血管瘤的效果 ,探讨治疗的适应证和制定治疗计划的注意点。方法 回顾性分析 1994年至 1995年间 ,γ刀治疗的 5 7例脑内海绵状血管瘤 ,边缘剂量平均为 2 0 .6Gy(9.0～ 2 5 .2Gy)。 30 %～ 80 %的等剂量曲线包绕病灶。运用质子磁共振波谱进行脑坏死的鉴别。结果 5 3例随访 (4.38+1.40 )年 ,4例失访 ,1例死亡。影像随访中 19例见病灶缩小。 5例治疗后 4～ 39个月再次出血。 2 1例 (6 0 % )治疗后癫痫发作频度和程度减轻 ,6例主诉癫痫未改善。 4例额叶海绵状血管瘤患者停药后未再出现癫痫。 17例病灶位于额顶叶及颞叶内侧功能区的患者治疗后 4～ 2 5个月出现肢体肌力减退、失语等症状。 33例病灶周围出现中到重度水肿 ,经脱水、激素及尼莫通扩血管治疗 ,4～ 14个月后影像随访 ,脑水肿明显减轻好转。 5例出现明显的肢体活动障碍。 2例治疗后 14、16个月行手术切除病灶。 3例出现明显视力下降。结论 边缘剂量 >16Gy时治疗后再出血比率明显减低。从治疗后再手术切除的病理标本中未找到血管瘤内机化闭塞的确切证据。脑内海绵状血管瘤的γ刀治疗必须慎重
Objective To evaluate the efficacy of stereotactic radiosurgery (γ-knife) in the treatment of intracerebral cavernous hemangioma, explore indications for treatment, and draw attention to treatment planning. METHODS: A retrospective analysis was performed of 57 cases of intracranial cavernous hemangioma treated with gamma knife from 1994 to 1995. The average edge dose was 20.6 Gy (9.0 to 25.2 Gy). A 30 to 80% isodose curve wraps around the lesion. Proton magnetic resonance spectroscopy was used to identify brain necrosis. Results Fifty-three patients were followed up for (4.38+1.40) years. Four patients were lost to follow-up and one patient died. In the follow-up of the imaging, the lesions were reduced in 19 cases. Five patients had rebleeding 4 to 39 months after treatment. In 21 cases (60%), the frequency and degree of epileptic seizures eased, and 6 cases complained of no improvement in epilepsy. Four patients with frontal lobe cavernous hemangioma did not show epilepsy after discontinuation. Among the 17 patients with focal lesions located in the frontal parietal lobe and the medial functional area of the temporal lobe, limb weakness and aphasia were observed 4 to 25 months after treatment. Middle to severe edema appeared around 33 lesions and was treated with dehydration, hormones, and nimotop vasodilatation. After 4 to 14 months of follow-up, brain edema was significantly reduced. Five patients had obvious physical activity disorders. Two patients underwent surgical resection 14 and 16 months after treatment. In 3 cases, significant visual loss occurred. Conclusion The rate of re-bleeding after treatment at the edge dose >16 Gy is significantly reduced. No clear evidence of intravascular hemangioma obliteration was found in pathological specimens after surgical resection. Gamma knife treatment of intracerebral cavernous hemangioma must be careful