Mixed craniopharyngioma: long-term results after gamma knife combined with stereotactic brachytherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for mixed cystic and solid craniopharyngiomas.</p><p><b>METHODS</b>Sixty-seven consecutive patients with mixed cystic and solid craniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic brachytherapy from October 1996 to December 2005 were selected for retrospective analysis. The inclusion criterion was the patients who survived for at least 5 years after combined treatment. There were 39 male and 28 female patients and the mean age was 31.5 years (ranged from 3 to 70 years). The clinical evaluations including neurological, neuro-ophthalmological, and neuro-endocrinological examinations, assessment of comprehensive quality of life and neuroimaging examinations were performed periodically. The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method. The rates were compared using the χ(2) test.</p><p><b>RESULTS</b>Follow-up period varied from 60 to 168 months, with an average of 114 months. The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9% respectively, and 89.6% in all. Mean survival after combination treatment was (110 ± 9) months. The mean survival of patients with predominantly solid and cystic craniopharyngioma were (97 ± 12) months and (120 ± 14) months and the actuarial 10-year survival rates were 7/12 and 69.1%. There was no statistics difference in tumor response rate and 10-year survival rate between 2 groups of patients with predominantly solid and cystic craniopharyngioma. The actuarial 5-, 6-, 7-, 8-, 9- and 10-year survival rates were 90.5%, 85.7%, 83.3%, 76.4%, 69.4% and 60.0% respectively. The decreased visual acuity had improved in 68.3% at 6 months postoperatively and in 70.0% in long term results. Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases(41.8%), good in 19 cases(28.4%), fair in 17 cases(25.4%) and poor in 3 cases(4.5%), respectively. The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity (4 patients), dysfunction of hypothalam (4 patients) and third nerve palsy was found in 1 patents 5 years after treatment. The rate of complications was 13.4%.</p><p><b>CONCLUSION</b>Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.</p>

Complications following gamma knife radiosurgery / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate complication features following gamma knife radiosurgery (GKR), and to assess factors causing complications.</p><p><b>METHODS</b>A retrospective analysis was conducted for 253 patients with intracranial arteriovenous malformation (AVMs), meningiomas, glial neoplasms, germinomas and metastatic cancer, respectively, which were treated with GKR.The incidences of acute, subacute and late complications following GKR were evaluated. Meanwhile, risk factors inducing subacute complications, such as the cell proliferative population of target tissues and location of target in AVM and meningioma, were evaluated, respectively.</p><p><b>RESULTS</b>The subacute complications are the prominent reactions in all the five diseases. There is a significant difference in the incidence rate of subacute complications between early responding tissues and slow responding tissues, central and peripheral AVM, basal and non-basal meningioma.</p><p><b>CONCLUSIONS</b>Subacute complications are the prominent reactions after GKR, and the reactions are almost always reversible. The risk of subacute complications following GKR treatment is correlated to the proliferative cell population in the target tissues and the target location (AVM, meningioma).</p>