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Gamma Knife Radiosurgery, an important
accessory in the treatment of Vesti bular
Schwannomas – a clinical study in 231
pati ents treated in the High Energy
Treatments Department
R. Perin, A.V. Ciurea, F. Stoica,
Rodica Stempurszki
“Bagdasar-Arseni” Clinical Emergency Hospital,
Bucharest
Vestibular Schwannomas (also known as acoustic
neuromas) are benign primary intracranial tumors,
that arise from the nerve sheath of the vestibulocochlear
cranial nerve (CN VIII). The clasic
therapy for this kind of tumors is microsurgical resection.
Unfortunatly the risk of facial paresis, in
case of total surgical resection, is signifi cant even
in the most experienced hands.
An alternative of Vestibular Schwannomas treatment
is Gamma Knife Radiosurgery. The Gamma
Knife was designed by the swedish neurosurgeon
Lars Leksell and his co-workers in 1967. A Gamma
Knife typically contains 201 cobalt-60 sources of
approximately 30 curies, each placed in a circular
array in a heavily shielded assembly. The device
aims gamma radiation through a target point in the
patient’s brain.
The Gamma Knife is limited only by the volume
of the vestibular schwannoma and by its relation to
the brainstem. It can be a good alternative treatment
for the tumor rest that occurs after partial or subtotal
resection. Also it can be used as a fi rst choice
treatment in tumors that are less than 8 cm 3 in volume.
The Gamma Knife treatment is very effective, a
good tumor control (growth stop or decrease) being
achieved in 93-98% of cases, with a 95-100% preservation
of the facial function and a 33-65% preservation
of the hearing (if functional preoperatively).
The present study refers to 231 patients, who
had a Gamma Knife treatment in the High Energy
Treatments Department, at the “Bagdasar-Arseni”
Clinical Emergency Hospital, Bucharest, between
October 2004 and April 2011.
In the above mentioned patients, 55% had been
operated previously and 45% had Gamma Knife
treatment as a fi rst choice. Tumor control has been
obtained in 98.5% of patients, facial function was
preserved in 100%, and hearing was preserved in
64.2% of cases (if functional preoperatively).
Conclusion: Gamma Knife Radiosurgery is an
effective second choice treatment, after microsur-
REVISTA MEDICALÅ ROMÂNÅ – VOLUMUL LIX, NR. 2, An 2012
gery, in the treatment of vestibular schwannomas.
It ca also be a good fi rst choice treatment in tumors
that do not exceed 8 cm 3 . The treatment effectiveness
obtained at Gamma Knife Bucharest compares
very well with the one found in the literature.
Key words: Gamma Knife, Radiosurgery, Vestibular
Schwannoma, Acoustic Neuroma, Microsurgery.
Studiul incidenţei cazurilor tratate de
enurezis din judeţul Dolj
Aida Bontea 1 , Simona Gusti 2 , Mihaela Zgabarus 3 ,
V. Iovanel 4
1 Spitalul Orăşenesc Segarcea, Pediatrie,
2 Departament de Fiziologie, Facultatea de Medicină,
Universitatea de Medicină şi Farmacie, Craiova
3 Spitalul Judeţean Râmnicu Vâlcea
4 Spitalul de Neuropsihiatrie Infanti lă, Craiova
Introducere
Enurezisul, afecţiune caracteristică copilăriei, se
manifestă prin urinări de obicei nocturne în aşternut,
ce apar şi după vârsta de 5 ani (considerată ca fi ind
limita de vârstă până la care copilul trebuie să-şi
controleze sfi ncterele). Se descriu două tipuri de
enurezis: primar, cauzat de o lipsă de maturare a
sis temului neurovegetativ, şi secundar, în cadrul
unor afecţiuni sistemice care asociază şi enurezis
alături de alte simptome.
Material şi metode
Au fost examinaţi clinic, neurologic, psihologic
paraclinic (investigaţii de laborator, electroencefalograme
cu aparatul Micromed) în perioada 2008-
2012 un număr de <strong>3.</strong>090 de copii (internaţi la
Spitalul de Neuropsihiatrie Craiova şi Spitalul Jude
ţean Craiova), din care 217 (7,02%) au prezentat
enurezis. Din acest lot au fost 78,81% cazuri de
enurezis primar şi 21,19% cazuri de enurezis secundar.
S-au examinat clinic, psihologic şi paraclinic
(ex plorări de laborator), electroencefalogramă
(EEG) cu aparatul Micromed.
Rezultate
Prematuritatea la naştere a fost înregistrată în
37,32% dintre cazuri, fi ind observată mai ales la
cazurile de enurezis primar. La examenul psihologic
s-au înregistrat factori psihologici de stres familial
în 54% dintre cazuri, întârziere psihică la 11,05%.
Pe electroencefalogramă s-au înregistrat trasee irita
tive în 39,63% dintre cazuri. Ca tratament, copiii