目的 探讨延髓肿瘤的治疗策略，以达到最佳预后。 方法 回顾分析2007年1月－2010年12月19例延髓肿瘤患者的临床资料，其中18例经外科手术治疗和病理证实，1例通过影像学确诊。 结果 12例血管网状细胞瘤中，11例手术全切，1例手术次全切；2例室管膜瘤均手术全切；2例海绵状血管瘤分别手术全切及伽马刀治疗；3例胶质瘤均手术部分切除。18例手术治疗患者术后神经功能障碍明显好转者13例，无明显变化者3例，2例因术后严重并发症死亡；1例伽马刀治疗患者症状好转。术后随访6～48个月，平均24个月。11例恢复工作，4例生活可自理，2例因肿瘤复发死亡。结论 术前通过MRI检查、术中神经电生理监测及熟练的显微外科技术是外科治疗优势，伽马刀治疗延髓较小肿瘤有着损伤小的优点，因此制定合理的治疗策略有利于提高患者生存质量。
【摘要】 目的 比较手术及伽马刀治疗lt;3 cm听神经瘤的优劣。 方法 由2名研究人员分别检索1990年1月1日—2010年3月31日四川大学网上图书馆CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等数据库的相关论文，选择证据级别最高的文献，使用Cochrane图书馆提供的RevMan 5.0软件，对手术和伽马刀治疗小型听神经瘤在面神经、听力功能保留的优劣方面进行Meta分析。 结果 共检索到4篇前瞻性队列研究，排除2篇。剩余的2篇文献共纳入患者173例，分析发现，在1年随访及随访结束时，手术治疗组与伽马刀治疗组相比，在面神经功能完整保留方面，P值及其95%CI分别为0.64（0.53，0.77）、0.67（0.47，0.96）；在保留有用听力方面，P值及其95%CI分别为0.08（0.02，0.27）及0.08（0.02，0.28）。 结论 伽马刀治疗lt;3 cm的听神经瘤，无论在保留有用听力还是面神经功能方面均明显优于手术。【Abstract】 Objective To compare surgery and gamma-knife treatment in treating acoustic neuroma less than 3 cm in diameter through Meta analysis. Methods Two researchers respectively searched relevant papers from such databases as CENTRAL, ISI, Medline, Embase, NLM Gateway, and CBMdisc posted on the online library of Sichuan University. Papers with the highest-grade evidence were selected, and RevMan 5.0 provided by Cochrane Library was used to compare surgery and gamma-knife treatment in the preservation of patients’ facial nerves and useful hearing through Meta analysis. Results Four prospective cohort studies were found, two of which were excluded. The remaining two articles were analyzed, and we compared surgery and gamma-knife treatment during the 1-year and the last follow-up period in facial nerve preservation and useful hearing preservation. The P value and 95% CI of the comparison was respectively 0.64 (0.53, 0.77) and 0.67 (0.47, 0.96) for facial nerve preservation, and 0.08 (0.02, 0.27) and 0.08 (0.02, 0.28) for useful hearing preservation. Conclusion Gamma-knife treatment for acoustic neuroma less than 3 cm in diameter is a much better choice than surgery in preserving hearing and facial nerve function.
ObjectiveTo clarify the characteristic of secondary cerebral amyloidoma which is relapsing in one year after seven years gamma knife radiosurgery and review relevant literature.MethodsTo analyze the clinical manifestation, preoperative and postoperative MRI imaging, inter-ictal and ictal electroencephalogram (EEG) and histopathological evaluation.ResultsThe patient suffered from epilepsy (mainly autonomic seizure and global tonic-clonic seizure) at the age of 22 and took a gamma knife radiosurgery for right medial temporal epilepsy as the refractory seizures occurred at the age of 36. In her 43 and 44 years’ old, she suddenly found left hemiplegia and mental retardation, the MRI showed right frontal and parietal space-occupying lesion and relapsed after the partial excision respectively, the inter-ictal and ictal EEG displayed persistent slow wave in the right hemisphere and spike wave located in the right posterior temporal and central-parietal, after the surgery, we found amyloid in the histopathological evaluation.ConclusionOne of the delayed complications of gamma knife radiosurgery is secondary cerebral amyloidoma, and partial excision may induced relapsing easily.