小脑毛细胞型星形细胞瘤的诊治分析

目的探讨小脑毛细胞型星形细胞瘤的临床诊断及显微手术治疗效果。方法对经病理证实的17例小脑毛细胞型星形细胞瘤的影像学表现、组织病理学特征、手术治疗方法及预后等进行分析、总结。结果小脑毛细胞型星形细胞瘤以20岁以下发病率最高;影像学上肿瘤可分为3种类型:完全囊肿型(2例,12%),囊肿结节型(7例53%),肿块型(6例35%)。病理学镜下表现为双极毛发样或纤维状细胞,伴Rosenthal纤维。手术所见肿瘤与周围组织间有相对清楚的边界。肿瘤全切除15例,大部切除2例。结论小脑毛细胞型星形细胞瘤有比较典型的影像学和病理学特征,显微手术全切是首选治疗方法,预后良好。     

儿童小脑毛细胞型星形细胞瘤的诊治(附15例报告)

目的总结儿童小脑毛细胞型星形细胞瘤的临床资料，探讨其诊治特点。方法分析儿童小脑毛细胞型星形细胞瘤15例的影像学、病理学特点及术中所见和预后情况。结果肿瘤全切除13例，次全切或大部切除2例。术后发热2例，均于术后3d内消失；头痛2例，随病情好转而逐渐消失。余病例未出现新的症状和体征。术后随访未见到复发。结论儿童小脑毛细胞型星形细胞瘤有其独特的临床特点，在条件允许的情况下应尽可能切除肿瘤。     

毛细胞型星形细胞瘤的诊断与治疗

目的分析毛细胞型星形细胞瘤的临床特点及诊治方法。方法回顾性分析解放军总医院1997年1月～2007年1月手术治疗的37例毛细胞型星形细胞瘤患者的临床资料。结果病理显示典型毛细胞型星形细胞瘤30例（81.2%）,黏液型毛细胞型星形细胞瘤7例（18.8%）;28例肿瘤全切,31例平均随访45个月。结论毛细胞型星形细胞瘤的诊断主要依赖MRI检查,显微手术全切肿瘤是本病的主要治疗方法,应在保留功能的前提下尽量切除肿瘤,术后放化疗存在争议,复发的肿瘤可再次手术;应加强对黏液型毛细胞型星形细胞瘤的认识。     

毛细胞型星形细胞瘤的诊断和治疗

目的　探讨毛细胞型星形细胞瘤发病特点、病理学和影像学表现以及治疗方法。方法　 回顾性分析我院近3年来47例经手术病理证实的毛细胞型星形细胞瘤临床资料。结果 47例患者平均发病年龄21岁,20岁以下28例(59.6％)。位于小脑及大脑半球者可分为囊性伴囊壁结节、假囊性伴囊壁结节、实质性3种影像学表现。鞍区、脑干、脊髓等部位多表现为实质性。镜下多可见到大量Rosenthal氏纤维。46例GFAP免疫标记阳性,38例Vim免疫标记阳性。随访20个月,全切组(36例)无肿瘤复发,部分残留组(11例)1例复发。22例术后放疗,随访期内无肿瘤复发,未放疗组1例肿瘤复发。结论 毛细胞型星形细胞瘤有比较典型的影像学和病理学特点,外科全切术是首选的治疗方法。对于未全切病例术后应行放疗。     

毛细胞型星形细胞瘤的诊断与治疗

目的 探讨毛细胞型星形细胞瘤的临床诊断和最佳治疗方案。方法 通过头颅CT、MRI和手术探讨此类肿瘤的发病率,常见部位,临床特点,手术疗效,预后与手术切除肿瘤程度以及与术后放疗的关系。结果 毛细胞型星形细胞瘤以20岁以下发病率最高77．4％,以小脑居首92%。临床表现以颅内压增高为主、其次共济失调。影像学CT和MRI没有特征性征象,诊断率50％以上,最后确诊主要依靠病理学。预后与手术切除程度有关,肿瘤全切除术后10年内存活率达95％、部分切除术后达72．7％。结论 (1)毛细胞型星形细胞瘤多发病于青少年,以小脑居首。(2)尽可能全切除肿瘤、术后无需放疗其预后良好,可视为“良性肿瘤”;若不能伞切除的病例,术后可给予放疗亦能达到理想的预后。     

毛细胞型星形细胞瘤诊治分析

目的探讨毛细胞型星形细胞瘤的诊治经验。方法回顾性分析60例经病理证实的毛细胞型星形细胞瘤的临床资料,肿瘤部位:颅后窝39例(小脑蚓部9例,小脑半球29例,脑干1例),脊髓7例,幕上脑叶4例,侧脑室内4例,鞍区6例。病例均接受显微外科手术,根据病变不同部位,选择合适手术入路。结果全切除56例,部分切除4例。部分切除者术后辅助放疗或伽玛刀治疗。随访6个月~10年,全切除者均无复发,部分切除者保持稳定,肿瘤无明显增长。结论毛细胞型星形细胞瘤是最低级别胶质瘤,若能全切除病变,无需辅助治疗,效果良好,预后极佳。对于未能全切除者,辅助放疗或伽玛刀治疗,也能取得良好疗效。     

第三脑室毛细胞型星形细胞瘤的治疗

目的总结第三脑室毛细胞型星形细胞瘤的临床特点和治疗经验。方法回顾分析过去9年间我们收治的8例第三脑室毛细胞型星形细胞瘤的临床资料。本组8例，占同期住院胶质瘤的0．6％，发病年龄平均为19岁，病变在第三脑室前部突向下丘脑／视路的2例，位于第三脑室中后部的6例。8例均行显微手术治疗，肿瘤位于第三脑室前部突向下丘脑／视路的采用经翼点入路；第三脑室中后部肿瘤选择经胼胝体-透明隔入路。结果肿瘤全切6例；2例部分切除，术后给予放射治疗。术后8例患者均治愈出院，7例患者出院随访1年无明显不适。结论毛细胞型星形细胞瘤为良性肿瘤，预后较好，显微手术切除和恰当的术后放射治疗效果较满意。     

黏液性毛细胞型星形细胞瘤

黏液性毛细胞型星形细胞瘤是一种最近才被描述的中枢神经系统肿瘤,其特点类似于毛细胞型星形细胞瘤,过去被归为毛细胞型星形细胞瘤的一个亚型。然而,最近的研究表明,黏液性毛细胞型星形细胞瘤的组织学特点和毛细胞型星形细胞瘤有细微的差异,在生物学特性上,两者之间在侵袭性,复发率和预后都有不同。提示了黏液性毛细胞型星形细胞瘤是一类不同于毛细胞型星形细胞瘤的肿瘤。深入了解毛细胞型星形细胞瘤和黏液性毛细胞型星形细胞瘤的组织学特点,临床表现,影像学特点,治疗原则,预后对进一步开展相关研究有重要意义。     

脊髓毛细胞型星形细胞瘤5例临床分析

目的 探讨脊髓毛细胞型星形细胞瘤(PA)的临床、影像学、病理学特点及治疗与预后.方法 回顾性分析5例脊髓PA患者的临床资料.5例患者均行手术全切除肿瘤,术后随访观察6～36个月.结果 本组5例患者均为成年人;术前MRI检查示肿瘤位于脊髓颈段2例、胸段1例、腰段1例、颈至腰段1例;首发症状为肢体疼痛4例、肢体麻木2例、肢...     

多形性黄色瘤型星形细胞瘤的诊治分析:附7例报道并文献复习

目的 探讨多形性黄色瘤型星形细胞瘤（PXA）的临床表现、影像学表现、病理特征、治疗及预后。方法 回顾性分析2011年7月至2019年7月手术治疗的7例PXA的临床资料,并复习相关文献。结果 7例均以癫痫发作起病;7例肿瘤均位于大脑浅表部位,MRI表现呈实性4例,呈囊实性3例;7例均在显微镜下全切,5例术后行适形放疗,2例间变型术后行同步放化疗;术后病理WHOⅡ级5例,Ⅲ级2例。术后随访6个月~8年,存活6例,术后2例复发,其中1例死亡。结论 PXA临床罕见,癫痫发作是最常见的症状,影像学表现具有一定特点,其病理学特征有别于其他星形细胞瘤,治疗上应手术全切,对术后有残余、复发或间变者可给予放、化疗。     

成人毛细胞型星形细胞瘤的诊治分析

目的 探讨成人毛细胞型星形细胞瘤（PA）的诊断、显微手术治疗效果。方法 回顾性分析2009年9月至2018年12月新疆医科大学第一附属医院神经外科手术治疗的31例成人PA的临床资料。结果 肿瘤全切除17例,近全切除4例,次全切除6例,部分切除2例,活检2例。术后主要并发症包括脑积水3例（9.7%）、颅内感染4例（12.9%）、脑脊液漏3例（9.7%）。26例术后随访3~93个月;死亡3例（11.5%）;肿瘤复发或进展5例（19.2%）,平均复发时间（25.6±16.9）个月,其中2例再次手术,肿瘤全切除本人随访期间未见肿瘤复发。结论 成人PA临床少见,影像学常不易与其它低级别胶质瘤鉴别,而典型的组织细胞学特点是其确诊依据;肿瘤全切除的本人能获得较满意的治疗效果,放疗为PA的主要辅助治疗方式。     

基于美国SEER数据库的儿童胶质瘤临床特点和预后分析

目的 基于美国SEER数据库回顾总结儿童胶质瘤的临床特点,并探究不同组织学类型的生存预后相关影响因素.方法 纳入SEER数据库中2000-2015年经组织病理学证实的胶质瘤患儿共7759例,根据组织学类型分为毛细胞型星形胶质瘤、髓母细胞瘤、室管膜瘤、胶质母细胞瘤及其他类型胶质瘤,绘制Kaplan-Meier生存曲线,比...     

Cortical ependymoma or monomorphous angiocentric glioma?

Ependymoma is the third most common childhood intracranial tumor after medulloblastoma and pilocytic astrocytoma. Most ependymomas occur in the posterior fossa and spinal cord but only five cases confined to the cerebral cortex have been reported. The current case is a 5‐year‐old boy with a somewhat ill‐defined cortical tumor diagnosed as pilocytic astrocytoma on biopsy, and treated with radiotherapy. Nine years later, resection of the essentially unaltered tumor was performed for treatment of intractable seizures. Histologically, the tumor had some areas with the typical appearance of ependymoma as well other areas which contained piloid cells. There was also evidence of focal infiltrative growth. These findings bore resemblance to a recently described entity monomorphous angiocentric glioma/angiocentric neuroepithelial tumor, which combines features of ependymoma with pilocytic and diffuse astrocytomas. Both cortical ependymomas and angiocentric monomorphous glioma/angiocentric neuroepithelial tumor appear to be low‐grade tumors although their rarity makes accurate prognosis problematic. The current case has features of both entities, suggesting they may be closely related.     

Pilocytic astrocytoma: unusual feature

Juvenile pilocytic astrocytoma is a well-defined brain tumor. It most often occurs in children and young adults. It is located in the posterior fossa and has typical imaging features, associating cystic and strongly contrast enhancing mural nodule. After complete surgical removal, its prognosis is excellent. Adult cases are seldom observed. They develop almost exclusively within the cerebral hemispheres and share the same imaging and prognostic characteristics as the pediatric forms. We describe the case of a 42-years-old man presenting with a huge heterogenous posterior fossa lesion. Histopathological analysis of the lesion after surgical resection diagnosed a juvenile pilocytic astrocytoma. These peculiar location and imaging features in an adult patient may be misdiagnosed for infectious lesions and must be recognized.     

Cerebellar astrocytomas: a 24-year experience

INTRODUCTION: Cerebellar astrocytomas are the most benign tumors of the CNS. Seventy to eighty percent are found in children. METHODS AND RESULTS: We report on 38 children under 18 who had cerebellar astrocytoma in the posterior fossa and were treated by a multidisciplinary team in our Neurosurgical Department from January 1974 to December 1997. We included all patients in whom the histopathological diagnosis was astrocytoma, regardless of malignancy. The diagnostic methods used were pneumoventriculography, cranial X-rays, CT scan, and MRI. All patients were treated surgically. Neither radiotherapy nor chemotherapy was indicated in patients with pilocytic or fibrillary astrocytomas. A greater prevalence was observed in female (25/38; 66%) than in male (13/38; 34%) patients. Histopathological results revealed 27 (71%) pilocytic astrocytomas, 8 (21%) diffuse fibrillary astrocytomas, 1 (2%) anaplastic astrocytoma and 2 (6%) glioblastomas. These tumors were more frequently located in the right cerebellar hemisphere; increased intracranial pressure syndrome was the most frequent form of clinical presentation. Total tumor resection was obtained in 29 (83%) cases and subtotal resection in 9 (17%). In 6 (16%) cases, ventriculoperitoneal shunts were placed to control persistent hydrocephalus after tumor excision. CONCLUSION: The most frequent complication was increased ataxia. The mortality rate was 8.5%.     

IV ventricle astrocytomas in childhood: clinicopathological features in 21 cases

The authors conducted a study of 21 children with benign astrocytomas in the IV ventricle treated with radical tumor resection from 1982 through 1991. The purposes of this study were to identify the tumor origin and neural involvement, and to determine the natural history following surgical resection. Pathological studies showed that 18 were pilocytic astrocytomas (pure pilocytic in 12, mixed in 6), 2 fibrillary, and 1 gemistocytic. In the IV ventricle, 12 patients had a transependymal involvement of the floor (brain stem), 6 had an involvement of the wall (cerebellar peduncle), and 3 had involvement of both floor and wall. A gross total resection was performed in 9 patients, and the remaining 12 patients underwent a subtotal resection. All patients were followed without radiation therapy (RT) or chemotherapy. During a follow-up period of 6.5–15 years, all patients were alive. Eight patients suffered recurrence between five months and 66 months after diagnosis. Of these, five received RT for recurrence and had a complete response in all cases. The remaining 13 patients showed no evidence of disease and one had a stable residual tumor. The recurrence-free 5-year and 10-year survival rates were 62.5% and 57% respectively. Patients without brainstem involvement, with total resection, or with pure pilocytic astrocytoma had a better outcome than those with brain stem involvement, with subtotal resection, or with nonpilocytic or mixed histology. In summary, a great majority of benign IV ventricle astrocytomas involve the floor of the IV ventricle. It is often difficult to determine the origin of these tumors in most cases. Benign IV ventricle astrocytomas may not recur even after incomplete resection, and close observation without RT is recommended, although RT appears to be effective for these tumors when they recur.