松果体区肿瘤诊治策略的探讨

目的 探讨松果体区肿瘤的诊治策略.方法 回顾性分析154例松果体区肿瘤的病例资料.结果 松果体区肿瘤多以颅高压、眼球运动障碍起病,诊断需进行CT、MRI及肿瘤标记物检查.基本确诊或高度怀疑生殖细胞瘤时直接放疗或活检后放疗23例,肿瘤均消失,5年生存率88.9%;其他肿瘤手术治疗131例,肿瘤全切除124例,次全切除7例,5年生存率84.4%.手术患者的病理结果:生殖细胞肿瘤60例,松果体实质肿瘤17例,神经上皮肿瘤27例,其他肿瘤27例.结论 松果体区肿瘤常合并脑积水,影像学表现有一定特征,联合肿瘤标记物检测能进一步鉴别肿瘤性质.基本确诊生殖细胞瘤直接选择放、化疗,高度怀疑生殖细胞瘤选择活检后放疗或实验性放疗,不能确定生殖细胞瘤时选择显微手术联合术后辅助放、化疗,在治疗过程中兼顾脑积水的处理是较理想的松果体区肿瘤的治疗策略.

Abstract：

Objective To define the optimal diagnosis and theraputic strategy of pineal region tumors.Method Clinical materials of 154 cases with pineal region tumors were analyzed retrospectively.Results The patients with pineal region tumors often complained with increased intracranial pressure and ocular movement deficiency.The procedure of diagnosis was imaging checking included CT and MRI,tumor mark testing.23 cases which were essential exact diagnosed or high doubt germinomas were choosed to direct radiotherapy or radiotherapy after biopsy.All the tumors disappeared during the follow up time.5 years survival rate was 88.9%.Other 131 cases were chosen for operation treatment.Total removal were achieved in 124 cases and subtotal were achieved in 7 cases.The 5 years survival rate was 84.4%.The operation pathological result included 60 germ cell tumors, 17 pineal parenchymal tumors, 27 neural epithelium tumors and 27 other tumors.Conclusions Pineal region tumors are often combined with hydrocephalus.There was some characteristic feature in the imaging appearance.The cases should be chosen to direct radiotherapy and chemotherapy if was diagnosed germinomas, and be choosed to radiotherapy after biopsy or experimental radiotherapy if was high doubt germinomas.The cases which unable determined germionmas should be choosed microsurgery and assist radiotherapy and chemotherapy postoperation.Hydrocephalus should be treated in consideration during the procedure of tumor treatment.     

儿童脑干胶质瘤32例临床分析

儿童脑干胶质瘤约占儿童脑肿瘤10%～15%,桥脑弥漫性胶质瘤又是脑干胶质瘤中一种独特类型,其临床特点、MRI表现、治疗原则和预后均有别于其他类型胶质瘤[1].     

颅内血管母细胞瘤的诊断和治疗（附23例报告）

血管母细胞瘤属良性肿瘤 ,好发于后颅窝 ,以成年男性多见 ,多为囊性 ,常有瘤结节 ,少数可为实质性。随着现代神经影像技术及手术条件的改善 ,其早期诊断率日益提高 ,彻底切除可取得满意的效果。我们于 1995年 3月至 2 0 0 1年 9月 ,共收治 2 3例 ,均行手术治疗 ,预后良好 ,报告如下。1　临床资料1.1　一般资料 :本组 2 3例中 ,男 15例 ,女 8例 ,占同期颅内肿瘤的 2 .1% ,年龄 19～ 5 7岁 ,平均 37.4岁 ;病程 15天～ 4年 ,平均 9个月。肿瘤位于幕上 3例 ,位于幕下 2 0例 ;其中囊性变 17例 ,实体性 6例 ;2例为肿瘤复发 ,1例有家族遗传史 ,3例 …     

中脑顶盖部胶质瘤的外科治疗

目的探讨中脑顶盖部胶质瘤的外科手术治疗方法及结果。方法回顾性分析9例中脑顶盖部胶质瘤病人的临床资料。均采用显微外科手术切除,其中枕部经小脑幕入路8例,经幕下小脑上入路1例。结果肿瘤均全切除,病理均为低级别胶质瘤,术后并发双眼上视困难1例,无其他手术并发症,无死亡病例。脑积水完全缓解8例,1例仍有头痛、呕吐症状,再次行内镜下第三脑室底造瘘术。所有病人随访1～5年,MRI未见肿瘤复发,眼球运动障碍有不同程度恢复,KPS评分90～100分。结论中脑顶盖部胶质瘤临床罕见,病理级别相对良性,进行积极的显微外科治疗能取得较好的效果。     

不同类型颅咽管瘤的组织炎症和细胞增殖性

目的研究不同病理类型颅咽管瘤的组织炎症及细胞增殖性对预后的影响.方法对30例经手术切除的颅咽管瘤组织采用免疫组织化学SP法检测白细胞共同抗原CD45和细胞周期相关核抗原Ki-67的抗体MIB-1的表达,分别计算CD45标记指数(CD45 LI)和MIB-1标记指数(MIB-1 LI).结果CD45标记的炎症反应在颅咽管瘤组织中广泛存在,MIB-1主要在颅咽管瘤基底细胞层表达.造釉细胞型颅咽管瘤组织CD45 LI(32.4%±15.0%)及细胞MIB-1 LI(18.2%±8.7%)显著性高于鳞状乳头型颅咽管瘤(分别为13.6±7.6%、7.1%±4.9%,P＜0.05).结论颅咽管瘤造釉细胞性较鳞状乳头型具有更强的组织炎症和细胞增殖性,可能是影响其预后的原因.     

颅内良性肿瘤放射外科治疗后再生长原因探讨

４例颅内良性肿瘤，行立体定向放射外科治疗事影像及病理证实肿瘤再生长。分析其原因为照射剂量不足，剂量分布不均匀以及肿瘤呈囊性。结果说明颅内良性肿瘤行立体定向放射我科治疗时增强肿瘤边缘有及毗邻脑重要部分的控制，确保达到有效治疗剂量是提高控制率，防止肿瘤再生长的关键。     

经前、后交通动脉栓塞外伤性颈动脉海绵窦瘘

1 病例资料 例1男,20岁,头部外伤后一年,因左侧搏动性突眼、红眼、颅内血管杂音住我院;造影示左侧高流量的颈内动脉海绵窦瘘(CCF).用可脱性球囊(Balt)栓塞,球囊充盈达极限后,造影仍见少量漏,拟更换更大的球囊栓塞,泄去造影剂,将球囊自瘘口撤出到颈内动脉(ICA),球囊突然脱落,被血流向上冲了约1 cm后被卡住.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

脑动脉瘤术中干预性载瘤动脉暂时阻断

目的探讨脑动脉瘤术中载瘤动脉暂时阻断的时机和方式。方法１８例脑动脉瘤患者，术中采用干预性载瘤动脉暂时阻断，阻断时间１８～５５ｍｉｎ，平均２７ｍｉｎ，每间隔８～１２ｍｉｎ原位松开阻断夹１０余秒，以防血栓形成，阻断超过３０ｍｉｎ则开放载瘤动脉３～５ｍｉｎ，１０例复合性控制低血压。结果术后再出血死亡１例，出现脑梗塞１例，其余１６例恢复良好。结论干预性载瘤动脉暂时阻断能明显降低动脉瘤术中成熟破裂的发生率，大部分病人能耐受分离瘤颈，夹闭动脉瘤所需时间的阻断     

SYBR荧光实时定量PCR检测不同病理类型颅咽管瘤ICAM-1 mRNA表达

目的定量研究细胞间粘附分子基因(ICAM—1 mRNA)在不同病理类型颅咽管瘤的表达差异及意义。方法收集30例经手术治疗的颅咽管瘤标本,采用SYBR荧光实时定量PCR法检测 ICAM-1 mRNA在肿瘤组织的表达,并对表达结果行统计学分析。结果造釉细胞型颅咽管瘤 ICAM-1mRNA表达量为(62．18±6．43)×103 copies／μg,鳞状乳头型颅咽管瘤ICAM-1 mRNA表达量为 (1．13±0．17)×103 copies／μg,造釉细胞型颅咽管瘤ICAM-1 mRNA表达量显著性高于鳞状乳头型颅咽管瘤(P<0．01)。结论两种病理类型颅咽管瘤ICAM—1 mRNA表达存在显著性差异,此差异性可能与两种病理类型颅咽管瘤不同的肿瘤炎症有关。