立体定向放射外科治疗前庭分裂瘤:治疗理念的演变

S. R. Ilyalov, A. Golanov, S. Banov
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引用次数: 0

摘要

前庭分裂瘤是小脑角最常见的肿瘤。在治疗这些肿瘤的方法中,立体定向放射外科手术与手术治疗并列。立体定向放射外科位于神经放射学、神经外科和放射治疗等几个临床专科的交叉点,每个专科都对这种治疗方法的发展做出了重要贡献。最常用的是以钴为基础的 Leksell 伽马刀,专门用于治疗颅内肿瘤。现代直线加速器和质子加速器也可用于治疗,它们可提供高精确度和高一致性的照射。自首次将这种方法应用于治疗前庭裂隙瘤以来,所积累的经验不仅优化了对肿瘤和邻近重要结构(脑干、内耳)的放射剂量,还研究了放射后微观和宏观变化的特征及其对临床过程的影响,并为不同大小的裂隙瘤放射外科手术提出了建议。所有这一切都有助于高度控制肿瘤生长和减少功能障碍,再加上容易耐受和住院时间短,决定了这种治疗方法与传统手术方法相比成本更低,具有显著的社会和经济效果。本讲座面向神经外科医生和放射治疗师,重点介绍影响立体定向放射外科治疗前庭分裂瘤的发展、推广和在临床实践中积极使用的最重要因素。
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Stereotactic radiosurgery for vestibular schwannomas: evolution of the philosophy of treatment
Vestibular schwannomas are the most common tumors in the cerebellopontine angle. Stereotactic radiosurgery is included in the armamentarium of methods for treating these tumors along with surgical treatment. Given the annual incidence of more than 15 radiosurgical cases of vestibular schwannomas per 1 million population, the expected need for stereotactic radiosurgery of these tumors in Russia is more than 2000 cases annually.Stereotactic radiosurgery is located at the intersection of several clinical specialties: neuroradiology, neurosurgery and radiation therapy, each of which has made a significant contribution to the development of this treatment method. The most commonly used for this is the cobalt‑based Leksell Gamma Knife, specifically intended for the treatment of intracranial neoplasms. Treatment is also possible with modern linear accelerators and proton accelerators, which provide high accuracy and conformity of irradiation. The experience gained since the first application of this method in the treatment of vestibular schwannomas has made it possible not only to optimize the radiation doses to the tumor and adjacent critical structures (brain stem, inner ear), but also to study the features of post‑radiation micro‑ and macro‑ changes, their impact on the clinical course, to develop recommendations for radiosurgery with schwannomas of various sizes. All this contributes to high control of tumor growth and a low level of functional disorders, which, along with easy tolerability and minimal hospitalization time, determines lower cost of this treatment compared to the traditional surgical approach and significant social and economic effect.This lecture is intended for neurosurgeons and radiation therapists and focuses on the most significant factors that influenced the development, promotion and active use of stereotactic radiosurgery of vestibular schwannomas in cli nical practice.
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