【摘要】 目的评价伽玛刀治疗累及视路的无功能型垂体腺瘤的适应证和疗效。方法对295例伽玛刀治疗后的无功能型垂体腺瘤患者进行MR I和垂体内分泌随访,并分肿瘤累及视路组与未累及视路组进行比较,随访时间6~106个月(平均35个月)。结果肿瘤累及视路的82例患者中,肿瘤体积缩小47例(57.3%),无变化30例(36.6%),增大5例(6.1%),其中有2例出现视力障碍加重;未累及视路的213例患者中,肿瘤体积缩小149例(70.0%),无变化61例(28.6%),增大3例(1.4%)。本组肿瘤总控制率为97.3%,伽玛刀治疗后出现新的垂体功能低下7例。结论伽玛刀治疗无功能型垂体腺瘤是有效和安全的,特别对未累及视路的患者并发症少。但对累及视路的病例,如果视路受压明显,应慎重考虑伽玛刀治疗。更多还原

【Abstract】 Objective A retrospective analysis assessed the efficiency of gamma knife radiosurgery for nonfunctioning pituitary adenoma involving visual pathway.Methods Imaging and endocrinological evaluations following gamma knife radiosurgery were performed in 295 patients with nonfunctioning pituitary adenoma,and the patients were divided into two groups according to the tumor involving visual pathway or not,followed up from 6 to 106 months(average 35 months).The mean margin dose of 82 cases of visual pathway involved patients was 13.4 Gy and the visual pathway suffered an average radiation dose of 8.6 Gy(7 to 10 Gy).To the 213 cases of visual pathway non-involved patients,the average margin dose was 14.7 Gy and the visual pathway suffered 6.2 Gy(3 to 9 Gy).Results 47 cases(57.3%) of tumor volume decreasing,30 cases(36.6%) of remaining unchanged,and 5 cases(6.1%) of increasing were found in the group of 82 visual pathway involved patients,2 cases presenting visual impairment.149 cases(70.0%) of tumor volume decreasing,61 cases(28.6%) of remaining unchanged,and 3 cases(1.4%) were found in the group of 213 visual pathway non-involved.The overall tumor control rate was 97.3%.7 patients suffered new hormone deficits following gamma surgery.Conclusion Gamma knife radiosurgery is efficient and safe for nonfunctioning pituitary adenomas,especially for visual pathway non-involved patients with few complications.But serious consideration should be taken for patients with obvious visual pathway compression.An intensive dose plan is essential to reduce the incidence of optic neuropathy.更多还原