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目的探讨立体定向穿刺抽吸手术与伽玛刀联合治疗颅内囊性肿瘤在立体定向放射外科治疗中的作用。方法分析颅内囊性肿瘤40例，单纯立体定向穿刺抽液19例，留置Ommaya囊抽液19例，内窥镜下手术切除肿瘤并排除囊液2例。肿瘤体积缩小后再行立体定向磁共振成像（MRI）定位、伽玛刀治疗，并计算抽液前后肿瘤体积的变化。依据Logistic综合方程计算抽液前后风险概率的变化，将抽液前后的肿瘤体积和风险概率进行配对t检验。结果抽液后瘤囊完全消失，病灶体积明显缩小。抽液前后肿瘤容积和风险概率均显著降低（容积变化：t＝8.108，P＜0．001；风险概率：t＝5．933，P＜0．001）。随访时间6个月～42个月，平均17.5个月。经伽玛刀治疗后，瘤结节消失10例，缩小12例，无变化17例，增大1例。结论颅内囊性肿瘤立体定向穿刺抽液后肿瘤体积缩小，使立体定向放射外科治疗并发症的风险概率显著降低，是联合伽玛刀治疗囊性肿瘤一种有效方法；针对肿瘤病理类型的不同采用伽玛刀放射外科联合单纯穿刺或置管抽取囊液、结合囊内治疗是囊性肿瘤治疗成功的关键。
Objective To investigate the effect of stereotactic aspiration and gamma knife in the treatment of intracranial cystic tumors in stereotactic radiosurgery. Methods Forty cases of intracranial cystic tumors were analyzed. Nineteen cases were treated with stereotactic aspiration, 19 cases were treated with Ommaya cyst fluid extraction, and the tumors were removed by endoscopy and 2 cases were excluded. Tumor volume was reduced and then stereotactic magnetic resonance imaging (MRI) positioning, gamma knife treatment, and calculate the changes in tumor volume before and after pumping fluid. According to the Logistic equation, the probability of risk before and after pumping was calculated, and the t test was performed on the tumor volume and risk probability before and after pumping. The results of the tumor capsule completely disappeared after pumping fluid, lesion volume was significantly reduced. Tumor volume and risk probability were significantly reduced before and after fluid withdrawal (volume change: t = 8.108, P <0.001; risk probability: t = 5.933, P <0.001). Follow-up time of 6 months to 42 months, an average of 17.5 months. After gamma knife treatment, tumor nodules disappeared in 10 cases, reduced in 12 cases, no change in 17 cases, an increase of 1 case. Conclusion The decrease of tumor volume after stereotactic aspiration of intracranial cystadenocarcinoma significantly reduces the risk probability of stereotactic radiosurgery complications and is an effective method to treat cystic tumors with gamma knife. According to the different tumor pathological types The use of gamma knife radiosurgery combined with simple puncture or catheter extraction cyst fluid, combined with intracapsular cystic tumor treatment is the key to the success.