摘要：

目的 探讨射波刀治疗海绵窦巨大海绵状血管瘤的有效性和安全性。方法 共7 例经影像学诊断的海绵窦巨大海绵状血管瘤患者，血管瘤体积11.86 ~ 70.12 cm³，中位值23.30 cm³，予射波刀分次治疗，计划靶区剂量归一70% ~ 80%，照射剂量21 Gy/3 次（5 例）、25 Gy/5 次（1 例）和30 Gy/3 次（1 例），照射野109 ~ 155 个，靶区体积覆盖95%以上。分别于术后即刻和随访时评价手术疗效和安全性。结果 术后随访6 ~ 18 个月（平均9.37 个月），临床症状均有所改善。术后仅1 例出现放射性脑水肿，予甘露醇和地塞米松治疗后缓解。复查MRI 显示，血管瘤体积6.75 ~ 28.35 cm³，中位值10.50 cm³，较术前缩小（Z = -2.366，P = 0.018）。结论 射波刀是治疗海绵窦巨大海绵状血管瘤的有效方法。对于不宜行传统手术切除和放射治疗的患者，建议首选射波刀治疗。

关键词: 血管瘤, 海绵状, 中枢神经系统, 海绵窦, 放射外科手术

Abstract:

Objective  To investigate the efficacy and safety of CyberKnife for giant cavernous hemangioma in cavernous sinus. Methods  The data of 7 cases of giant cavernous hemangioma in cavernous sinus region confirmed by imaging examination and treated with CyberKnife were collected. The tumor volume was 11.86-70.12 cm³ (median 23.30 cm³). CT and MRI were acquired and fused by MIM 6.5.4 software. The acquired data sets were imported into a CyberKnife Robotic Radiosurgery System (Multiplan 4.0.2) and used to delineate the target organs at risk. The irradiation doses received by the lesions were 21 Gy/3 times in 5 cases, 25 Gy/5 times in one case and 30 Gy/3 times in one case. The exposure field was 109-155, and target volume reached over 95%. Patients maintained at supine positionduring treatment and utilized a 6D-skull trace mode specific to CyberKnife. Changes of clinical symptoms and imaging immediately after treatment and during follow-up period were observed to evaluate the efficacy and safety of this therapeutic method. Results  Patients were followed-up for 6-18 months, and the meanfollow-up period was 9.37 months. Volumes of lesions were calculated after operation. All of these patients showed decrease in tumor volume (35.48% to 84.03% ) and improvement in symptoms (including visual impairment, visual field defect and headaches) after therapy. Postoperative MRI revealed the tumor volume was 6.75-28.35 cm³ (median 10.50 cm³), which were significantly lower than that of before treatment [11.86-70.12 cm³ (median 23.30 cm³); Z = -2.366, P = 0.018]. Only one case presented radioactive cerebral edema, and the symptom was disappeared after 5-day treatment with mannitol and dexamethasone. Conclusions  CyberKnife is an effective treatment method for giant cavernous hemangioma in cavernous sinus region. It is suggested to be the first selection for patients with giant cavernous hemangioma in cavernous sinus, who are not suitable for traditional surgeries and general radiotherapy.

Key words: Hemangioma, cavernous, central nervous system, Cavernous sinus, Radiosurgery