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Neurological Surgery No Shinkei Geka Volume 37, Issue 12 （December 2009）

Neurological Surgery 脳神経外科 37巻12号（2009年12月発行）

Japanese English

研究

定位放射線治療後の放射線障害―特に良性疾患の長期経過観察例について Radiation Injury After Stereotactic Irradiaton: Especially Long Term Follow-up Benign of Targets 松尾孝之 ¹ , 林之茂 ¹ , 氏福健太 ¹ , 馬場史郎 ¹ , 鎌田健作 ¹ , 林靖之 ² , 永田泉 ¹ Takayuki MATSUO ¹ , Yukishige HAYASHI ¹ , Kenta UJIFUKU ¹ , Shiro BABA ¹ , Kensaku KAMADA ¹ , Nobuyuki HAYASHI ² , Izumi NAGATA ¹ ¹長崎大学医学部歯学部附属病院脳神経外科 ²長崎大学医学部歯学部附属病院放射線学科 ¹Department of Neurosurgery,Nagasaki University School of Medicine ²Department of Radiology,Nagasaki University School of Medicine キーワード： linac based radiosurgery , radiation injury , arteriovenous malformation (AVM) , vertebral shwannoma , meningioma Keyword: linac based radiosurgery , radiation injury , arteriovenous malformation (AVM) , vertebral shwannoma , meningioma pp.1201-1206

発行日 2009年12月10日 Published Date 2009/12/10

DOI https://doi.org/10.11477/mf.1436101069

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　良性病変に対する定位的放射線治療では長期的な放射線障害の出現とその治療は重要な懸案事項である．本報告ではlinac based radiosurgery後の放射線障害について，画像変化および臨床症状の出現に着目し，今後の治療計画において注意すべき事柄を検討した．

　Objective: To analyses the result of linac radiosurgery (LRS) for the treatment of intracranial benign lesions and to assess possible factors related to complications.

　Methods: The authors retrospectively reviewed 204 patients treated with LRS between May, 1993 and December, 2003. The study determined the correlation between radiosurgical complications including imaging changes after LRS and multiple factors such as radiosurgical parameters, location, volume and shape. We divided the patients into three groups by MRI imaging changes and clinical symptoms. Group 1 (Gr.1): Imaging change only. Group 2 (Gr.2): Imaging change with transient symptoms. Group 3 (Gr.3): Imaging change with permanent symptoms.

　Result: Ninty-three patient with AVM: Gr.1, 8 cases (8.6%), Gr.2, 1 case (1.1%), Gr.3, 2 cases (2.1%). A significantly higher incidence of imaging change was noted in patients with arteriovenous malformation (AVM) volumes greater than 10cc, irregular shape of the nidus and deep location. Fifty-eight patients with vestibulan schwannoma (VS): Gr.1, 6 cases (10.3%), Gr.2, 1 case (1.8%), Gr.3, 2 cases (3.4%). Imaging changes were seen mostly in cases with tumor volume greater than 5cc. Fifty-three patients with meningioma: Gr.1, 4 cases (7.5%), Gr.2, 2 cases (3.7%), Gr.3, 0 case. Imaging changes were seen mostly in convexity, parasaggital, and falx meningiomas that were deeply embedded in the cortex. The symptom continued the until last serial observation in four cases. We used various interventions in these patients including steroid, anticoagulant, surgical removal, and hyperbaric oxygen therapy; but these therapies were not effective.

　Conclusion: LRS for each disease seems to be a safe and effective treatment. However, once serious radiation injuries occur there is no effective therapy, so it is important to make appropriate selection of patients for radiosurgery.