散発性血管芽腫に対する手術・ガンマナイフによる長期治療成績
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概要
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Object: The purpose of this study is to evaluate the long-term results of surgery or Gamma knife radiosurgery (GKRS) for sporadic hemangioblastomas (sHBL). Methods: Twenty nine patients with sHBL (16 male and 13 female patients [mean age 42.3 years; range 17-76 years]) were included in this study. Tumor location was cerebellum in 22 patients, medulla in 3, and spine in 2. Two patients have multiple lesions. Sixteen sHBL were cystic type and 11 were solid type. Results: 1. As the first treatment, surgical resection was performed in 26 patients and GKRS was performed in 2. 2. Recurrence occurred in 9 cases (32.1%) during mean 8 years and 6 months; range 22-300 months. Recurrence was correlated with solid type, multiple, and partial/subtotal removal. 3. Surgery was performed in 8 cases 10 times and GKRS was performed in 5 as treatment of recurrence. 4. Seven cases were treated with GKRS at a mean marginal dose of 14.1 Gy. Of these 7 cases, tumor size was well controlled in 6, however, one patient with medullary solid type developed perifocal edema by cyst formation 11 years and 6 months after GKRS. 5. In two cases, hemangioblastomatosis developed 10 years and 3 months or 10 years after first surgery. 6. Glasgow Outcome Scale was GR in 21 cases, MD in 2, SD in 2, VS in 2, and D in 1 after mean 8 years and 2 months; range 6-303 months. Conclusions: 1. Recurrences tend to occur in solid, multiple, and partial/subtotal removal cases and hemangioblastomatosis would develop in some cases about 10 years after surgery. 2. Tumor size will be well controlled by GKRS using relative lower dose, however, recurrence will occur by cyst formation, so careful follow-up should be necessary.
- 2004-03-01
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