视交叉-下丘脑胶质瘤的诊断与治疗

目的探讨视交叉下丘脑胶质瘤的近代诊治。方法回顾性分析１９８３～１９９７年２８例视交叉下丘脑胶质瘤的临床表现，手术方法和疗效。结果本组以头痛、视力障碍和内分泌改变为主要临床表现。ＭＲＩ是主要的诊断方法。根据肿瘤主体部位选择手术入路。肿瘤全切除、次全切除和部分切除分别为８、１２、８例。术后症状好转１６例，７例出现下丘脑相关的症状群。严重下丘脑反应４例在术后１周内死亡。１６例随访５个月至１０年，平均３５年，５例在２年内死亡，１１例Ｋａｒｎｏｆｓｋｙ评分为５０～６０分。结论视交叉下丘脑胶质瘤的恶性程度与年龄有关。手术可切除肿瘤，明确诊断，恢复脑脊液循环。但是不强求全切，保存功能和减少对周围组织的损伤，是减少手术后并发症的关键，结合放疗和化疗，可使患者长期生存。

Diagnosis and treatment of optic chiasmatic hypothalamic glioma.

Objective To investigate the status of diagnosis and treatment of optic chiasmatic hypothalamic glioma (OCHG). Methods A retrospective review of 28 cases with OCHG surgically treated between 1983 1997 was conducted, focusing on their clinical features, surgical approaches and outcomes.Results Headache, vision disturbance and endocrine changes were main complaints.MRI was major diagnostic modality. Unilateral subforntal, subfrontal trans lamina terminalis and pterional approaches were applied for the tumors with main lesions in optic chiasma, transcallosal and transventricle approaches for main lesions in the third ventricle. Total, subtotal and partial removal of tumors were achieved in 8, 12, 8 cases respectively. Symptoms and signs were improved in 16 cases. Seven cases showed hypothalamic related signs. Four cases died from severe hypothalamic reactions within one week after operations. Sixteen cases were followed up from 5 months to 10 years. Five cases died in two years after surgeries. Karnofsky scales of 11 patients were 50 60. Conclusions Malignany of OCHG is related with age. Surgery is necessary for definire diagnosis and reestablishment of CSF pathway, for the resection of exophytic and suprasellar tumors or the lesions in the third ventricle. It is important for decreased complications to perform no intentional radical surgery and lessen damage of surrounding tissues. The patients who got safe operations and chemotherapy or radiotherapy will have longer time survival.