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目的评价伽玛刀治疗侵袭海绵窦垂体腺瘤的疗效和内分泌激素变化,并分析了治疗后主要的并发症。方法选择了自1995年9月至2006年1月收治的并获得完全随访资料的128例侵袭海绵窦垂体腺瘤患者,肿瘤直径1.0～4.8 cm(平均3.04 cm),既往手术63例,具有放疗史22例。PRL腺瘤56例,GH腺瘤19例,ACTH腺瘤2例,FSH腺瘤1例,混合性腺瘤22例,无功能性腺瘤28例。采用Leksell立体定位系统,边缘剂量12～35 Gy(平均19.56 Gy),等剂量线45%～50%。平均随访时间34个月。结果大部分病人均可耐受伽玛刀治疗,急性并发症很少出现。晚期并发症主要表现为视力下降和垂体功能低下。伽玛刀治疗后,肿瘤消失的为4例,肿瘤缩小的为94例,肿瘤大小无变化的26例,4例患者治疗后肿瘤增大,总的肿瘤控制率为96.87%。同时对于功能性腺瘤,于治疗后11例激素水平恢复正常,58例患者激素水平较治疗前下降。结论伽玛刀治疗侵袭性垂体腺瘤是一种安全、有效的治疗方法。
Objective To evaluate the efficacy and endocrine hormones of gamma knife in treating cavernous sinus pituitary adenoma and to analyze the main complications after the treatment. Methods A total of 128 patients with invasive cavernous sinus pituitary adenoma who received complete follow-up data from September 1995 to January 2006 were selected. The diameter of the tumor was 1.0-4.8 cm (average 3.04 cm). There were 63 cases of previous surgery with radiotherapy History of 22 cases. 56 cases of PRL adenoma, 19 cases of GH adenoma, 2 cases of ACTH adenoma, 1 case of FSH adenoma, 22 cases of mixed adenoma and 28 cases of non-functioning adenoma. Using Leksell stereotactic system, the marginal dose of 12 ~ 35 Gy (average 19.56 Gy), isodose line 45% to 50%. The average follow-up time was 34 months. Results Most patients were tolerant to gamma knife treatment and acute complications were rare. Late complications mainly manifested as vision loss and hypopituitarism. Gamma knife treatment, the tumor disappeared in 4 cases, 94 cases of tumor shrinkage, no change in the size of the tumor in 26 cases, 4 patients after treatment, the tumor increased, the total tumor control rate was 96.87%. At the same time for functional adenoma, hormone levels returned to normal after treatment in 11 cases, 58 patients with hormone levels than before treatment decreased. Conclusion Gamma knife treatment of invasive pituitary adenoma is a safe and effective treatment.