立体定向间质内放射治疗丘脑胶质瘤的临床分析

报告采用ＣＴ引导下立体定向间质内放射治疗丘脑胶质瘤２６例，其中男１６例，女性１０例，肿瘤位于左侧丘脑１１例，右侧丘脑１５例，其中胶质瘤Ⅰ组７例，Ⅱ级１５例，多形胶质母细胞瘤４例。随访时间最长３年零５个月，随访中发现死亡１２例，死亡率为４２．３％。本组无手术死亡。     

经额叶侧脑室脉络膜裂入路丘脑胶质瘤切除术

目的 研究经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤的手术方法.方法 采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤20例,在冠状缝前约1.5 cm、冠状缝后不超过1 cm内分离额上沟并切除部分额中回,进入侧脑室体部.根据丘脑肿瘤主体与脉络膜裂的关系,4例在脉络膜裂的内侧纵形进入第三脑室,切除突出于第三脑室的丘脑肿瘤;16例在脉络膜裂的外侧切除丘脑肿瘤.结果 1例肿瘤切除范围小于50%,余19例切除范围大于90%;病理结果:胶质瘤Ⅱ级3例,Ⅲ级9例,Ⅳ级8例.围手术期死亡1例.随访无癫痫发生,GOS评分:良好16例,重残1例,死亡2例.结论 丘脑胶质瘤的手术仍存在较大的困难,采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤,取得较理想的效果.     

经额叶侧脑室脉络膜裂入路丘脑胶质瘤切除术

目的 研究经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤的手术方法.方法 采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤20例,在冠状缝前约1.5 cm、冠状缝后不超过1 cm内分离额上沟并切除部分额中回,进入侧脑室体部.根据丘脑肿瘤主体与脉络膜裂的关系,4例在脉络膜裂的内侧纵形进入第三脑室,切除突出于第三脑室的丘脑肿瘤;16例在脉络膜裂的外侧切除丘脑肿瘤.结果 1例肿瘤切除范围小于50%,余19例切除范围大于90%;病理结果:胶质瘤Ⅱ级3例,Ⅲ级9例,Ⅳ级8例.围手术期死亡1例.随访无癫痫发生,GOS评分:良好16例,重残1例,死亡2例.结论 丘脑胶质瘤的手术仍存在较大的困难,采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤,取得较理想的效果.     

丘脑胶质瘤的显微手术治疗

目的 探讨丘脑胶质瘤显微外科治疗的安全性和有效性。方法 回顾性分析2014年1月至2017年12月显微手术治疗的11例丘脑胶质瘤的临床资料。结果 肿瘤全切除5例，次全切除4例，大部分切除2例。7例术后症状改善，3例无明显变化，1例加重。无手术死亡病例。11例随访9~27个月；7例因肿瘤复发死亡，中位生存时间12.4个月（9~17个月）；1例术后16个月复发，目前随访19个月仍存活；其余3例临床症状稳定，影像学随访未见肿瘤复发。结论 显微手术是治疗丘脑胶质瘤的有效手段，手术入路需根据术前影像学检查结果个性化制定；熟练掌握显微神经外科技术和辅助技术（包括神经导航、电生理监测等）可降低手术并发症发生率和病死率。     

脑干胶质瘤的手术治疗

目的：研究探讨脑干胶质瘤手术适应征和手术方法。方法：总结我院自１９９０年以来采用显微外科手术治疗１５例脑干胶质瘤的经验。结果：１５例患者手术后病情好转为１０例，３例无变化，另２例病情加重死亡。结论：外生型脑干胶质瘤，局限型或有较大囊变、出血坏死的内生型脑干胶质瘤可考虑手术治疗。其中部分病人已获得较好效果。     

丘脑及脑干占位病变的显微与激光手术

本文总结１８例丘脑及脑干占位性病变的显微与激光手术治疗体会。其中４例位于丘脑，中脑者２例，桥脑者６例，延髓者６例。除１例桥脑胶质瘤术后第三个月死于肿瘤复发呼吸衰竭，１例丘脑肿瘤于术后１年死于再手术后感染外，其他皆有良好的神经功能恢复．１２例于术中后２～３周作ＣＴ／ＭＲ检查，显示有明显改善．随访５个月～２年无症状复发表现．本文就丘脑及脑干占位病变的手术适应证、手术入路及激光应用作重点讨论．     

复发胶质瘤伽玛刀治疗的初步报告

对４８例经手术治疗，术后放疗和化疗后复发的胶质瘤进行了伽玛刀治疗，肿瘤直径１１．３－６９．８ｍｍ，平均３５ｍｍ；肿瘤中心剂量２２－５５ＧＹ，平均３２ＧＹ；肿瘤周边剂量１１－２０ＧＹ，平均１５ＧＹ；照射的等中心数１－１５个，平均７个。获得随访４０例，随访时间９－２２个月，平均１４个月。至最后一次随访时，１６例死亡，１２例病情恶化，３例症状好转，９例病情无加重。     

视交叉-下丘脑胶质瘤的临床诊治分析

目的探讨视交叉-下丘脑胶质瘤的临床特点及其诊治。方法回顾分析2001年6月至2007年6月我科收治的18例视交叉-下丘脑胶质瘤的临床表现、影像学特征及手术治疗情况。结果18例视交叉-下丘脑胶质瘤患者中，2～23岁16例，32岁和49岁各1例；2例患者伴发神经纤维瘤病Ⅰ型。常见首发症状为头痛。肿瘤次全切除1例，大部分切除13例，部分切除2例，仅活检2例。星形细胞瘤Ⅰ级16例，Ⅱ级2例。术后均辅以放疗和，或化疗。12例随访1～5年，存活9例，死亡3例。结论视交叉一下丘脑胶质瘤需与颅咽管瘤鉴别。手术以改善症状、明确诊断为目的。采取手术、放疗及化疗的综合治疗，患者预后较佳。     

儿童丘脑胶质瘤的显微外科治疗

目的 探讨儿童丘脑胶质瘤的临床特征和显微外科治疗.方法 总结49例儿童丘脑胶质瘤的临床特征,分别采取经胼胝体-穹窿间入路、胼胝体-侧脑室入路、经顶或顶枕-侧脑室(经三角区)入路、经额-侧脑室入路、经颞皮层入路、经颞下小脑幕入路进行显微外科治疗.结果 初次手术中,近全切除23例,大部切除17例,部分切除9例,围手术期死亡2例.39例获得随访,16例存活,其中15例生活可以自理.结论 手术是儿童丘脑胶质瘤的首选治疗,根据肿瘤的位置、生长方向及术者经验采取合理的手术入路,尽可能减少重要结构的损伤,减少术后并发症.     

成人丘脑恶性胶质瘤手术治疗

目的探讨成人单侧丘脑胶质瘤的临床特点及显微外科治疗。方法总结16例丘脑肿瘤的临床特点,结合肿瘤位置分别采用多种入路切除肿瘤。10例患者术中行弥散张量成像功能核磁导航辅助,15例患者术后早期放化疗。结果肿瘤全切15例(94%),近全切1例(6%)。术后1 w改善患者9例(56%);如故患者7例(44%)。术后失神发作1例,部分运动性失语1例,无手术直接死亡。2例术后脑积水行脑室-腹腔分流术,1例术后张力性积液行立体定向穿刺术。病理15例Ⅲ~Ⅳ级,1例Ⅱ级。随访14~28个月(平均17.9个月),目前除1例未早期放化疗患者复发外,余15例患者中有5例复发,时间为术后3~16个月,平均9.8个月,其中3例已经死亡(存活13~20个月,平均17个月),均为肿瘤复发播散。1年存活率100%,1年无进展生存75.0%,2年存活率81.0%,2年无进展生存62.5%。结论显微外科技术进步结合神经导航技术的发展,使得手术最大范围切除丘脑胶质瘤病残率及死亡率已明显降低,丘脑胶质瘤治疗首选最大范围手术切除,术后应辅以必要的放疗和化疗等综合治疗。     

高级别胶质瘤同步放化疗中替莫唑胺化疗的不良反应分析

目的替莫唑胺是一种新型烷化剂,因其口服给药、生物利用度好、良好的血脑屏障通透性以及突出的治疗效果,越来越广泛地用于胶质瘤治疗,但其不良反应仍有待深入研究。本文探讨替莫唑胺不良反应的发生、后果、影响因素、防治原则。方法分析在同步放化疗当中使用替莫唑胺化疗的高级别胶质瘤患者的资料,包括肿瘤类型,替莫唑胺化疗期间血常规、血生化检查,不良反应等指标。依据药物毒副反应判定标准NCI-CTC 3.0对不良反应进行判定。结果共33例患者使用替莫唑胺,年龄23~76岁,中位年龄46岁,男性18例,女性15例,均为高级别胶质瘤术后行替莫唑胺同步放化疗。其中血液学毒性发生4例(12.1%),胃肠道反应共15例(45.5%),乏力12例(36.4%),皮肤病变2例(6.1%),一过性视物模糊3例(9.1%)。除1例血液学毒性3~4级外,其余毒性均为1~2级。其中女性不良反应发生率高于男性,而肿瘤级别对不良反应无影响。结论替莫唑胺是目前胶质瘤治疗的常用药物,通过对替莫唑胺联合放射治疗过程中的不良反应分析,显示其不良反应较轻微,且给予对症处理后均能明显缓解。因此,在对恶性脑胶质瘤患者使用同步放射治疗及化学治疗中,替莫唑胺的应用是安全的。     

Evaluation of proximal facial nerve conduction by transcranial magnetic stimulation.

A magnetic stimulator was used for direct transcutaneous stimulation of the intracranial portion of the facial nerve in 15 normal subjects and in patients with Bell's palsy, demyelinating neuropathy, traumatic facial palsy and pontine glioma. Compound muscle action potentials (CMAPs) thus elicited in the orbicularis oris muscle of controls were of similar amplitude but longer latency (1.3 SD 0.15 ms) compared with CMAPs produced by conventional electrical stimulation at the stylomastoid foramen. No response to magnetic stimulation could be recorded from the affected side in 15 of 16 patients with Bell's palsy. Serial studies in two patients demonstrated that the facial nerve remained inexcitable by magnetic stimulation despite marked improvement in clinical function. In the patient with a pontine glioma, the CMAP elicited by transcranial magnetic stimulation was of low amplitude but normal latency. In six of seven patients with demyelinating neuropathy, the response to intracranial magnetic stimulation was significantly delayed. Magnetic stimulation produced no response in either patient with traumatic facial palsy. Although the precise site of facial nerve stimulation is uncertain, evidence points to the labyrinthine segment of the facial canal as the most likely location.     

胶质瘤性脑水肿发生与胶质细胞水通道4的初步实验研究

目的　探索胶质瘤性脑水肿的病理生理变化及其分子机制。方法　利用体外血 -脑脊液屏障模型研究胶质瘤细胞对血 -脑脊液屏障水转运的影响。采用半定量 RT-PCR方法分析胶质瘤细胞作用后体外血 -脑脊液屏障模型胶质细胞水通道 4( AQP4)的表达变化。结果　胶质瘤细胞可明显增强体外血 -脑脊液屏障模型对水由内皮细胞腔面向基底面的扩散 ,这一过程不依赖于清蛋白等大分子物质的通透性变化。同时 ,胶质瘤细胞明显降低了胶质细胞 AQP4的表达水平。结论　胶质瘤细胞可明显增强体外血 -脑脊液屏障模型对水由内皮细胞腔面向基底面的扩散。胶质瘤性脑水肿不一定是血浆等大分子物质通透性增加的结果。胶质瘤细胞对胶质细胞 AQP4的影响是胶质瘤性脑水肿产生的重要分子机制之一     

Laterality of brain tumors

Tumor laterality was evaluated with respect to presenting symptoms and demographic factors among 489 adults with histologically confirmed glioma (354 high-grade, 135 low-grade), 197 with meningioma, and 96 with acoustic neuroma. The ratio of left-sided to right-sided tumors did not differ significantly from 1.00 for any of the major tumor types. Low-grade glioma and meningioma occurred nonsignificantly more often on the left side, whereas high-grade glioma and acoustic neuroma occurred nonsignificantly more often on the right side. Aphasia or mental status changes were significantly more common among glioma patients with tumors on the left side than among those with tumors on the right side. Associations between tumor laterality and symptoms may influence the probability or timing of diagnosis, possibly differentially by marital status.     

Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study

With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.     

Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990 to 2003

Objectives To assess the long-term survival of brain tumor patients, and in particular to evaluate the relation of quality of life (QOL) to survival among low-grade glioma patients. Methods The postoperative survival of 101 brain tumor patients was followed from surgery (1990–1992) until the end of the year 2003. Depression was evaluated by the Beck Depression Inventory (BDI) and QOL with Sintonen’s 15D scale before operation and at one year as well as at five years after operation. Results The mean survival times in years (SD) were significantly related to tumor malignancy, being the shortest, 1.9 (0.6), for patients with high-grade gliomas, while patients with low-grade gliomas or a benign brain tumor had mean survival times of 9.1 (1.0) and 11.6 (0.5), respectively. At all follow-ups, depressed low-grade glioma patients had a significantly shorter survival time, 3.3–5.8 years, compared to non-depressed low-grade glioma patients, 10.0–11.7 years. A decreased level of QOL in low-grade glioma patients was significantly related to the shorter survival. Conclusions The results suggest that depression and decreased QOL among low-grade glioma patients is related to shorter survival at long-term follow-up. Decreased QOL may serve as an indicator for poor prognosis in low-grade glioma patients.     

TEM8在人脑胶质瘤中的表达及其意义

目的 探讨肿瘤内皮标记物8（TEM8）在人脑胶质瘤组织中的表达特点及其意义。方法 采用免疫组化法检测84例脑胶质瘤及15例颅脑损伤减压手术切除的正常脑组织标本TEM8的表达,并分析TEM8表达与胶质瘤临床病理特征及预后的关系。结果 胶质瘤TEM8高表达率（47.6%,40/84）明显高于正常脑组织（6.7%,1/15;P<0.01）。高级别胶质瘤TEM8高表达率（64.4%,29/45）显著高于低级别胶质瘤（28.2%,11/39;P<0.01）。TEM8表达与胶质瘤患者性别,年龄,肿瘤部位和大小无关（P>0.05）。TEM8高表达胶质瘤患者中位生存期（24.5个月）明显长于TEM8低表达胶质瘤患者中位生存期（36.0个月;P<0.05）。结论 胶质瘤组织TEM8呈高表达,并且与胶质瘤级别和预后显著相关。     

5-FU多聚缓释体植入技术治疗脑胶质瘤

目的观察5-氟尿嘧啶(5-FU)多聚缓释体植入胶质瘤内化疗的临床效果,探索化疗药物的新剂型和新途径。方法在60例胶质瘤病人在开颅术中或以立体定向方式植入5-FU多聚缓释体,5-FU含量100～150mg。随访5～24周,通过影像学检查,计算肿瘤平均径。比较手术前及各随访时间段肿瘤平均径的变化,并观察瘤周水肿情况。结果38例病人术后病情稳定。无化疗不良反应。肿瘤平均径在术后5、12和24周以上均有显著缩小。其中第12周随访病例肿瘤平均径缩小最显著。肿瘤周边水肿带在开颅手术的病人比较宽,而在立体定向手术病人无明显加重表现。结论低剂量5-FU瘤内缓释体植入术治疗脑胶质瘤安全有效,无明显不良反应。     

Therapy and survival of adult patients with intracranial glioma in a defined population

During the 3 years 1978-1980 146 adult patients with intracranial glioma were diagnosed in the Province of Uusimaa in southern Finland. The median survival of all patients was 15 months, of glioblastoma (n = 41) 5.1 months, of anaplastic astrocytoma (n = 29) 12.4 months, of benign grade I-II astrocytoma (n = 30) 93.5 months, of other glioma 82.9 months (n = 27), and of probable glioma 9.8 months (n = 19); 22 patients are still alive 8.9-11.9 years after diagnosis. The patients who were 15-44 years of age at the time of diagnosis survived 75.4 months in the median (n = 58), 45-64 years 10.5 months (n = 61) and 65 years or older 4.8 months (n = 27); 96 patients were operated, 89 received radiotherapy and 34 chemotherapy. According to the proportional hazards' model, follow-up time, age and histological type of tumor were statistically highly significant in explaining differences in survival.     

人胶质瘤干细胞样抗原致敏树突状细胞疫苗Ⅰ期临床试验研究

目的 探讨胶质瘤干细胞样抗原致敏DC疫苗在临床应用的可行性、安全性及有效性.方法 选取5例复发胶质瘤患者;二次手术后体外无血清培养胶质瘤细胞,CD133磁珠分选和X线照射后获取干细胞样抗原;同体外周血单核细胞经GM-CSF、IL-4诱导后再与干细胞样抗原共孵育获得成熟DC疫苗;每周1次皮下接种DC疫苗,共3次,联合替莫唑胺化疗.观察不良反应,头颅MRI增强随访及生存期评估疗效.结果 5例胶质瘤标本中均含有不同比率的CD133+细胞,DC疫苗接种后患者无明显不良反应,患者平均生存期为72.2周.结论 干细胞样抗原致敏DC疫苗对于胶质瘤患者安全可行,联合化疗能延长患者生存期.

Abstract：

Objective To investigate the feasibility ,safety and efficiency of dendritic cells (DCs) vaccine pulsed with tumor stem - like associated antigens against malignant glioma in recurrent patients.Method Cells derived from fresh specimens of recurrent gliomas in serum - free medium were magenetically sorted with CD133 -antibody and irradiated with X -ray to attain freeze -thaw lysates.Autologous DCs from mononuclear cells with GM-CSF and IL-4 were matured by the lysates.Five patients with recurrent glioma received the DCs vaccine once a week (3 times ) followed combination with chemotherapy after recurrent tumor resection.Follow - up was procedured with MRI scans and clinical protocol.Results Five malignant glioma cell lines contained different ratio of CD133 + cells.DCs were successfully prepared and applied in all patients.No side -effect was observed.Mean survival time was 72.2 weeks.Conclusions Combination of DCs vaccine and chemotherapy is safe and may benefit the patients with malignant glioma.