Стереотаксическая лучевая терапия в лечении менингиом медиальных отделов средней черепной ямки тема диссертации и автореферата по ВАК РФ 14.01.18, кандидат медицинских наук Галкин, Михаил Викторович

• Галкин, Михаил Викторович
• кандидат медицинских наук
• 2011

Оглавление диссертации кандидат медицинских наук Галкин, Михаил Викторович

СОДЕРЖАНИЕ.

СПИСОК СОКРАЩЕНИЙ.

ВВЕДЕНИЕ.

Введение диссертации (часть автореферата) на тему «Стереотаксическая лучевая терапия в лечении менингиом медиальных отделов средней черепной ямки»

Цель работы.7

Задачи работы.7

Научная новизна.8

Практическая значимость.8

Внедрение в практику.8

Заключение диссертации по теме «Нейрохирургия», Галкин, Михаил Викторович

выводы

1. Менингиомы медиальных отделов средней черепной ямки -преимущественно радикально неоперабельные опухоли. При отсутствии абсолютных показаний к: оперативному лечению возможно проведение лучевого лечения. При тесном контакте опухоли с передними отделами зрительного пути и при большом объеме опухоли (>14 см ) целесообразно облучения в режиме стандартного фракционирования;

2. Разработанная методика комплексной динамической оценки менингиомы. включает совмещение снимков и сопоставление' границ опухоли на соответствующих срезах и сравнение объема мишени, основанное на погрешности; измерения; Данный подход, обеспечивает объективность и высокую точность оценки ответа опухолшна лечение.

3. Стереотаксическая конформная радиотерапия на, линейном ускорителе электронов является высокоэффективным методом лечения менингиом медиальных отделов средней черепной ямки, который позволяет достичь высоких значений контроля роста опухоли (96,8% при среднем периоде наблюдения 31,6 месяцев). . „ .

4. Оптимальным по соотношению' контроля роста опухоли и безопасности является облучение в режиме стандартного фракционирования в виде 30 фракций с разовой дозой 1,8 Гр до суммарной очаговой дозы 54 Гр.

5. Развитие осложнений после проведеншг стереотаксической лучевой терапии связано с подведением-большей дозы (56-60 Гр), существованием неразрешенной компрессией зрительного нерва, наличие лучевой терапии в анамнезе. В случае прогрессивного нарастания зрительных нарушений при неразрешенной компрессии зрительного нерва целесообразно выполнение декомпрессивной операции. . .

6. Улучшение функции черепных нервов после стереотаксического фракционированного облучения менингиом медиальных отделов средней черепной ямки происходит более чем у 40% пациентов, зрительные функции улучшаются более чем в 30% случаев. Вероятность улучшения зрительных по" функций после облучения достоверно выше при коротком анамнезе (в среднем — 28 мес), чем при длительном существовании нарушений (в среднем - 57,6 мес). Проведенное ранее удаление опухоли уменьшает вероятность улучшения функции III и V черепных нервов.

ПРАКТИЧЕСКИЕ РЕКОМЕНДАЦИИ

1. При отсутствии абсолютных показаний к оперативному лечению менингиомы медиальных отделов средней черепной ямки возможно проведение лучевого лечения. Проведение облучения в режиме стандартного фракционирования целесообразно при тесном контакте опухоли с передними отделами зрительного о пути и при большом объеме опухоли (>14 см ).

2. Предлучевое обследование пациентов с менингиомами медиальных отделов средней черепной ямки должно включать неврологический и нейроофтальмологический осмотры, МРТ и КТ с контрастным усилением. При отсутствии гистологической верификации КТ-перфузионное исследование должно подтвердить диагноз* в большей части случаев. В' случае неопределенности диагноза после полного клинического обследования показана биопсия.

3. Менингиомы медиальных отделов средней черепной ямки характеризуются сложным характером роста. Для выделения всей опухоли и критических структур следует использовать все доступньгё методы исследования- (МРТ и КТ с" контрастным усилением) и проекции.

4. При-тесном контакте менингиомы медиальных отделов средней черепной ямки с передними отделами зрительного пути или при большом объеме мишени (>14 см) облучение целесообразно проводить в режиме классического фракционирования за 30 фракций размеров 1,8 Гр до суммарной очаговой дозы 54 Гр.

5. Катамнестическое наблюдение за пациентами с менингиомами медиальных отделов средней черепной ямки после лучевой терапии включает обследование каждые 6 месяцев в течение первого'* года после лечения, далее каждый'год до 3" лет после облучения и затем раз в два года. Обследование должно включать осмотр невролога, нейроофтальмолога и МРТ до и после введения контрастного вещества.

6. Оценка нейровизуализационного ответа менингиом медиальных отделов средней черепной ямки на облучение должна включать в себя сопоставление старых и новых контуров опухоли и оценку динамики объема мишени.

7. В случае прогрессивного нарастания зрительных нарушений при неразрешенной компрессии зрительного нерва целесообразно выполнение декомпрессивной операции.

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