Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors : Treatment Concept and Outcomes in 120 Cases
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概要
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Availability of modern computer-aided robotized devices, such as the Automatic Positioning System (APSTM; Elekta Instruments AB, Stockholm, Sweden) and PerfexionTM (Elekta Instruments AB), allowed us to develop the original concept of robotic gamma knife microradiosurgery, which is based on the very precise irradiation of the lesion with regard to conformity and selectivity; intentional avoidance of the excessive irradiation of functionally-important anatomical structures, particularly cranial nerves, located both within and in the vicinity of the target; and delivery of sufficient irradiation energy to the tumor with the intention to attain lesion shrinkage, while keeping the marginal dose sufficiently low for prevention of possible complications. The results of such treatment strategy were evaluated retrospectively in 120 patients with benign cavernous sinus neoplasms (pituitary adenomas, meningiomas, schwannomas, and hemangiomas), who were followed up from 24 to 78 months (mean 47 months) after radiosurgery. Tumor growth control and shrinkage rates were 98% and 68%, respectively. More than 50% volume reduction was noted in 25% of lesions. The most prominent volumetric tumor response was observed in hemangiomas, followed by schwannomas, pituitary adenomas, and meningiomas. Treatment-related complications were marked in 7% of cases, and were mainly related to transient isolated cranial neuropathy appearing within several months after radiosurgery. Major morbidity was limited to one patient (0.8%). Application of microradiosurgical treatment principles provides effective and safe management of benign cavernous sinus tumors and is associated with high probability of lesion shrinkage and minimal risk of complications.
- 2012-10-15
著者
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岡田 芳和
島根医科大学脳神経外科
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岡田 芳和
Department Of Neurosurgery Tokyo Women's Medical University
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Takakura Kintomo
Department Of Neurosurgery Neurological Institute Tokyo Women's Medical University
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Okada Yoshikazu
Department Of Medical Informatics Tokai University School Of Medicine
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Hayashi Motohiro
Department Of Neurosurgery Neurological Institute Tokyo Women's Medical University
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MURAGAKI YOSHIHIRO
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
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Chernov Mikhail
Department Of Neurosurgery Neurological Institute Tokyo Women's Medical University
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Iseki Hiroshi
Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Wo
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Iseki Hiroshi
Department Of Neurosurgery Neurological Institute Tokyo Women's Medical College
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Tamura Manabu
Department Of Materials Science And Engineering National Defense Academy
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Muragaki Yoshihiro
Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Wo
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Tamura Noriko
Department Of Applied Physics Faculty Of Engineering University Of Tokyo
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Takakura Kintomo
Department Of Neurosuegery National Cancer Center Hospotal
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Okada Yoshikazu
Department Of Neurosurgery Neurological Institute Tokyo Women's Medical University
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Tamura Manabu
Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Wo
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Takakura Kintomo
Faculty Of Advanced Technosurgery Division Of Advanced Biomedical Engineering & Science Graduate
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Konishi Yoshiyuki
Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Women's Medical University
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HORIBA Ayako
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
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Horiba Ayako
Department Of Neurosurgery Neurological Institute Tokyo Women's Medical University
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MURAGAKI Yoshihiro
Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University
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