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Radiosurgical Treatment of Cavernous Sinus Neoplasms: Indications and Results

机译：海绵窦肿瘤的放射外科治疗：适应症和结果

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Although most pathologic tumors that involve the cavernous sinus are benign, the intimate association of these tumors to critical neurovascular structures makes their surgical resection difficult. Stereotactic radiosurgery provides effective tumor control with minimal morbidity. Its success with respect to meningiomas of the cavernous sinus is measured by its long-term tumor control rate and safety, and its success with respect to pituitary adenomas is measured by both endocrinologic control in addition to arrest of tumor growth. In a recent series of 186 patients with cavernous sinus meningiomas treated at the University of Pittsburgh, the authors observed a 5-year tumor control rate of 93% for typical meningiomas. Using marginal tumor doses of 13 Gy, the authors achieved long-term growth control and preserved neurologic function in most patients. By keeping the optic nerve dose less than 8 Gy and by using a marginal tumor dose of 13 Gy, they kept the risk of adverse radiation effects to 6.7%. The role of radiosurgery for pituitary adenomas requires careful analysis of the patient's visual, hormonal, and medical condition. The authors currently consider radio-surgery a viable alternative to microsurgery for patients with nonhormone-producing pituitary adenomas with cavernous sinus extension as long as they do not suffer from visual compromise from tumor compression of the optic apparatus. For patients with hormone-producing pituitary adenomas extending into the cavernous sinus, the authors favor microsurgery as the primary management modality and use radiosurgery for persistent/recurrent tumors or for patients who are not considered good candidates for surgical resection.
机译：尽管大多数涉及海绵窦的病理性肿瘤都是良性的，但这些肿瘤与关键的神经血管结构的紧密联系使它们的手术切除变得困难。立体定向放射外科手术可有效控制肿瘤，并将发病率降至最低。它对海绵窦脑膜瘤的成功是通过长期的肿瘤控制率和安全性来衡量的，对于垂体腺瘤的成功是通过内分泌控制和肿瘤生长的抑制来衡量的。在匹兹堡大学接受治疗的186例海绵窦性脑膜瘤患者的最新系列研究中，作者观察到典型脑膜瘤的5年肿瘤控制率为93％。使用13 Gy的边缘肿瘤剂量，作者实现了大多数患者的长期生长控制并保留了神经功能。通过使视神经剂量小于8 Gy，并使用13 Gy的边缘肿瘤剂量，他们将不良放射效应的风险保持在6.7％。放射外科治疗垂体腺瘤的作用需要仔细分析患者的视觉，激素和医疗状况。作者目前认为，对于非产生激素的垂体腺瘤伴海绵窦延长的患者，只要他们不会因视神经瘤的压迫而遭受视觉损害，放射线手术是显微手术的可行替代方案。对于具有产生激素的垂体腺瘤延伸至海绵窦的患者，作者赞成显微外科手术作为主要的治疗方式，并对持续性/复发性肿瘤或不被认为是手术切除的良好候选者使用放射外科手术。

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