neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-23-2-57-65neurosurgery-1032Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTСохранение функции лицевого нерва при стереотаксической радиохирургии опухолей мостомозжечковой цистерныFacial nerve preservation in stereotactic radiosurgery of tumors of the cerebellopontine cisternhttps://orcid.org/0000-0002-1572-5798ИльяловС. Р.IlyalovS. R.

Сергей Рустамович Ильялов

249031 Обнинск, ул. Королева, 

Sergey Rustamovich Ilyalov

4 Koroleva St., Obninsk 249031

sergeyilyalov@gmail.comКвашнинК. М.KvashninK. M.

249031 Обнинск, ул. Королева, 4

4 Koroleva St., Obninsk 249031

https://orcid.org/0000-0001-6844-3076МедведеваК. Е.MedvedevaK. E.

249031 Обнинск, ул. Королева, 4

4 Koroleva St., Obninsk 249031

https://orcid.org/0000-0002-8112-8043БаулинА. А.BaulinA. A.

249031 Обнинск, ул. Королева, 4

4 Koroleva St., Obninsk 249031

https://orcid.org/0000-0002-1868-6894ЛепилинаО. Г.LepilinaO. G.

249031 Обнинск, ул. Королева, 4

4 Koroleva St., Obninsk 249031

ПаршунинаА. М.ParshuninaА. M.

249031 Обнинск, ул. Королева, 4

4 Koroleva St., Obninsk 249031

СыгайН. А.SygayN. A.

010000 Нур-Султан, просп. Туран, 34/1

34/1 Turan Ave., Nur-Sultan 010000

Центр высокоточной радиологии Gamma Clinic (ООО Гамма Медтехнологии)РоссияCenter for high-precision radiology Gamma Clinic (LLC Gamma Medtekhnologii)Russian FederationНациональный центр нейрохирургии, АОКазахстанJSC National Center for NeurosurgeryKazakhstan2021100620212325765Copyright © Ильялов С.Р., Квашнин К.М., Медведева К.Е., Баулин А.А., Лепилина О.Г., Паршунина А.М., Сыгай Н.А., 20212021Ильялов С.Р., Квашнин К.М., Медведева К.Е., Баулин А.А., Лепилина О.Г., Паршунина А.М., Сыгай Н.А.Ilyalov S.R., Kvashnin K.M., Medvedeva K.E., Baulin A.A., Lepilina O.G., Parshunina А.M., Sygay N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1032Введение

Введение. Основным методом лечения опухолей мостомозжечковой цистерны (ММЦ) остается хирургическая операция, но она несет высокий риск нарушения функции черепных нервов. Радиохирургические вмешательства обычно используются в качестве дополнительного метода лечения, но могут проводиться и как самостоятельный вариант. Цель исследования - оценить безопасность рутинного применения радиохирургии для сохранения мимической функции при лечении опухолей различной природы, расположенных в ММЦ.

Материалы и методы

Материалы и методы. С марта 2018 г. по март 2020 г. в Центре высокоточной радиологии Gamma Clinic проведено лечение 145 пациентов с опухолями ММЦ. У 116 (80 %) пациентов выявлены вестибулярные шванномы (из них 37 - рецидивы или остатки после операции), у 22 - менингиомы (6 из которых - после открытой операции (I степень)), у 3 - тригеминальные шванномы, у 2 - фациальные шванномы, у 1 - шваннома каудальной группы нервов, у 1 - метастаз рака предстательной железы. Лицевой парез различной степени наблюдался у 31 пациента после предыдущей операции, а среди неоперированных пациентов - только у 1. Радиохирургическое вмешательство было проведено на аппарате Leksell Gamma Knife Perfexion, средняя краевая доза составила 12,2 Гр (11-15 Гр), средний объем опухоли составил 3,98 см3 (0,06-17,47 см3).

Результаты

Результаты. Под дальнейшим наблюдением находились 85 пациентов. Средняя длительность наблюдения -359,3 дня (91-776 дней), медиана - 367 дней. Уменьшение объема опухоли зарегистрировано у 27 пациентов, стабилизация процесса - у 15. Уменьшение в среднем составило 23,9 % (95 % доверительный интервал 16,831,0 %). Постлучевое увеличение наблюдалось в 30 случаях (только шванномы), в среднем оно составило 53,7 % (95 % доверительный интервал 38,5-68,9 %). У ранее оперированных пациентов лицевой парез во всех случаях сохранялся. Из пациентов, которые не были прооперированы до радиохирургического вмешательства, только у 1 (1,8 %) было отмечено развитие лицевого пареза (III степени по шкале House-Brackman) через 5 мес после облучения. Следует особо отметить, что функция лицевого нерва осталась сохранной (I степень по шкале House-Brackman) у обоих пациентов с фациальными шванномами. Не выявлено также ни одного случая гемифациального спазма.

Заключение

Заключение. Радиохирургия опухолей ММЦ с краевой дозой от 12 до 15 Гр характеризуется высокой безопасностью в отношении лицевого нерва. Это позволяет обосновать применение радиохирургии как альтернативы традиционным нейрохирургическим вмешательствам.

Introduction

Introduction. Surgery has traditionally remained the main treatment for tumors of the cerebellopontine cistern but is associated with high risks of dysfunction of the cranial nerves. Radiosurgery is usually performed both as an adjuvant treatment and as an independent option.

The study objective is to assess the safety of routine use of radiosurgery to preserve facial nerve function in the treatment of tumors of different origins located in the cerebellopontine cistern.

Materials and methods

Materials and methods. Since March 2018 to March 2020 there were 145 patients with tumors of cerebellopontine cistern (CPC) at the Center for High-Precision Radiology. Vestibilar schwannomas were detected in 116 (80 %) patients, in 37 cases - relapses or remains after surgery. The 22 patients had meningiomas, 6 after open surgery (WHO I). Trigeminal schwannomas - in 3 patients, facial schwannomas - in 2, jugular schwannomas - in 1 and metastasis of prostate cancer - in 1. 31 patients had facial paresis of different degrees after previous surgery. Among non-operated patients, facial paresis before radiosurgery was observed in only 1 patient. Radiosurgery was performed using the Leksell Gamma Knife Perfexion, the mean marginal dose was 12.2 Gy (11-15 Gy), the mean tumor volume was 3.98 cm3 (0.06-17.47 cm3).

Results

Results. Follow-up was performed in 85 patients. The mean follow-up was 359.3 days (91-776), the median follow-up was 367 days. Reduction of the tumor volume was detected in 27 patients, stabilization of the process in 15. The average decrease was 23.9 % (95 % CI 16.8-31.0 %). Transient postirradiation increase was observed in 30 patients only in the group of schwannomas and mean tumor volume increase was 53.7 % (95 % CI 38.5-68.9 %). In patients with previous surgery there were not cases of decline or regression facial paresis. Among patients who had not been operated on before radiosurgery, only in 1 case was the development of facial paresis (House-Brackman III) 5 months after irradiation, which amounted to 1.8 %. It should be especially noted that facial nerve function remained unchanged (House-Brackman I) in both patients with facial schwannomas. Also, not a single case of hemifacial spasm was identified.

Conclusion

Conclusion. Radiosurgery of CPC tumors with a marginal dose from 12 to 15 Gy has a high degree of safety in relation to the facial nerve. This makes it possible to justify radiosurgery as alternative to traditional neurosurgical interventions.

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The authors declare that there are no conflicts of interest present.