论文部分内容阅读
目的：探讨γ刀治疗后的病人再入神经外科行其他治疗的原因及方法。方法：γ刀治疗后３２例因病灶周围水肿加剧，脑积水明显增加，肿瘤体积增大，病灶出血引起蛛网膜下腔出血入神经外科。其中脑血管病（ＡＶＭ）１０例，鞍区肿瘤７例，胶质瘤８例，脑膜瘤或听神经瘤７例。结果：开颅手术１４例，其他治疗１８例，４例死亡，２例自动出院。４例死亡原因分别为胶质瘤γ刀治疗后脑室内出血，胶质瘤γ刀治疗后广泛水肿，家属拒绝手术治疗，小脑蚓部血管母细胞瘤γ刀治疗２年后出血，左顶巨大ＡＶＭγ刀治疗后半年出血。结论：选择病人行γ刀治疗时，要根据病变以及诸多因素加以考虑。普遍认为血管增生效应和对细胞毒性作用是放射效应的两个重要方面。尽管不同病变对放射有各种反应，不同剂量对同一病变产生的反应也各异，但通常认为病理改变有以下几期：反应水肿期、缺血坏死期、吸收与瘢痕期。
Objective: To investigate the causes and methods of other treatment after neurosurgery re-entry after γ-knife treatment. Methods: After 32 cases of γ-knife treatment, the edema around the lesion was aggravated, the hydrocephalus was obviously increased, the tumor size increased, and the hemorrhage of the subarachnoid hemorrhage was caused by neurosurgery. Including cerebrovascular disease (AVM) in 10 cases, 7 cases of sella region, glioma in 8 cases, meningioma or acoustic neuroma in 7 cases. Results: Craniotomy was performed in 14 cases, other treatments were in 18 cases, 4 cases died and 2 cases were discharged automatically. Four cases of death were glioma gamma knife treatment of intraventricular hemorrhage, glioma after extensive treatment of γ-knife edema, family refused to surgery, cerebellar vermis hemangioblastoma G knife 2 years after treatment of bleeding, left Top huge AVMγ knife bleeding after six months of treatment. Conclusion: The selection of patients with γ-knife treatment, according to the disease and many factors to be considered. It is generally accepted that both vascular proliferative effects and cytotoxic effects are two important aspects of radiation effects. Although different lesions have a variety of responses to radiation, different doses of the same lesion also have different responses, but the pathological changes are generally considered to have the following period: reaction edema, ischemic necrosis, absorption and scarring.