小儿下丘脑胶质瘤的诊断和治疗

目的为探讨小儿下丘脑胶质瘤的临床特点、诊断及治疗。方法对1996年11月至2001年9月间收治的27例小儿下丘脑胶质瘤作回顾性分析。结果27例小儿下丘脑胶质瘤占同期小儿颅内肿瘤的1．9％，占鞍区肿瘤的6．9％。临床表现主要为颅内压增高和下丘脑损害。27例中全切除4例和次全切除17例和大部分切除6例，无死亡病例。其中21例术后行放疗。随访23例，效果满意19例，生活能自理3例，植物生存1例。结论小儿下丘脑胶质瘤诊断应根据临床表现及神经放射学检查综合分析。显微外科手术治疗是主要有效的治疗方法，未全切除术后应放疗。     

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。     

视交叉-下丘脑胶质瘤的临床分型及手术治疗

目的　提高视交叉 下丘脑胶质瘤显微手术治疗水平。方法　回顾性分析 16例视交叉 下丘脑胶质瘤的影像学、手术资料及疗效。结果　本组全切除 6例 ,次全切除 4例 ,大部分切除 4例 ;根据肿瘤累及部位 ,视交叉 下丘脑胶质瘤可以分为 5型 :单纯视交叉型、视交叉 视神经型、视交叉 垂体柄型、视交叉 下丘脑型和弥散型 ,各型肿瘤在临床表现及手术学特点方面有所不同。 14例经过 2个月～ 5年的随访 ,除 1例再次手术后死亡其余均存活。结论　根据肿瘤累及部位 ,采用合适的手术技巧积极行显微手术切除 ,术后辅以放射治疗可以使大多数视交叉 下丘脑胶质瘤患者获得长期存活。     

视交叉—下丘脑胶质瘤（附28例临床分析）

视交叉-下丘脑胶质瘤是视通路胶质瘤的重要组成,它由视交叉胶质瘤向后侵犯下丘脑或下丘脑胶质瘤向前侵犯视交叉而形成,要明确区分它们的起源非常困难,所以通     

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。     

低级别胶质瘤的外科治疗及预后分析

2007年世界卫生组织(WHO)中枢神经系统肿瘤组织学分级标准将WHO Ⅰ～Ⅱ级星形细胞起源肿瘤、少突胶质细胞起源肿瘤和混合性胶质瘤统称为低级别胶质瘤[1],约占胶质瘤的25%[2],最终多演变为高级别、致命性肿瘤[3,4].     

胶质瘤术中荧光素钠实时显像的应用分析

目的 探讨荧光素钠术中实时显像在胶质瘤手术中的应用价值.方法 回顾性分析128例术中应用荧光素钠实时显像的胶质瘤病人的临床资料,其中肿瘤位于不利手术区域78例,位于有利手术区域50例.根据术中使用荧光素钠后肿瘤是否显色分为染色组和未染色组.结果 在有利手术区域,染色组全切除40例(95%),次全切除2例;未染色组全切除2例(25%),次全切除6例,两组全切除率差异有统计学意义(P <0.001).在不利手术区域,两组全切除率差异无统计学意义(P=0.122),但染色组术后KPS评分明显高于术前(P= 0.002),未染色组手术前后KPS评分无显著差异(P= 0.335).染色组平均手术时间、术后平均住院时间均较未染色组缩短(P= 0.002和P = 0.001),结论术中荧光素钠实时荧光显像对胶质瘤治疗和预后有意义.     

脑胶质瘤外科手术的进步

尽管单纯的外科干预还不能治愈弥漫浸润性胶质瘤,但在临床处理原则中,手术通常是恶性胶质瘤起始和主要的治疗步骤。在前瞻性随机临床试验尚不充分的情况下,弥漫性胶质瘤切除程度与患者生存期获益的评估主要依赖于回顾性临床数据分析。现有证据表明,广泛的手术切除可以延长高级别肿瘤患者的生存预期。外科治疗不仅可以明确组织病理学和分子病理学诊断、减少肿瘤细胞负荷、降低颅内压、缓解神经功能障碍,还可以为制定和实施辅助放化疗方案创造有利条件。因此,外科处理对胶质瘤治疗的意义是肯定的[1]。     

丘脑胶质瘤的外科治疗

丘脑胶质瘤位于脑深部，毗邻下丘脑、内囊、第三脑室等重要结构，具有独特的临床和影像特点，手术操作复杂、临床治疗困难．是神经外科比较棘手的疾病。现有手术入路包括经额、经顶、经颞、经顶枕脑室丘脑肿瘤切除术，经胼胝体前部、胼胝体后部脑室丘脑肿瘤切除术．经胼胝体穹窿间丘脑肿瘤切除术，经侧裂丘脑肿瘤切除术和经幕下小脑上丘脑肿瘤切除术等。本文就其临床表现、诊断和外科治疗情况加以综述。     

脑干胶质瘤治疗现状

<正>脑干肿瘤由于生长在生命中枢,致残率和致死率高,严重威胁着人类的生命健康。脑干胶质瘤占原发脑干肿瘤的75%,治疗方法及效果多年来一直是人们所关注的热点[1]。近年来,随着科学技术的进     

Surgical strategies in low-grade gliomas and implications for long-term quality of life

Reports on long-term health related quality of life (HRQL) after surgery for World Health Organization grade II diffuse low-grade gliomas (LGG) are rare. We aimed to compare long-term HRQL in two hospital cohorts with different surgical strategies. Biopsy and watchful waiting was favored in one hospital, while early resections guided with three-dimensional (3D) ultrasound was favored in the other. With a population-based approach 153 patients with histologically verified LGG treated from 1998–2009 were included. Patients still alive were contacted for HRQL assessment (n = 91) using generic (EQ-5D; EuroQol Group, Rotterdam, The Netherlands) and disease specific (EORTC QLQ-C30 and BN20; EORTC Quality of Life Department, Brussels, Belgium) questionnaires. Results on HRQL were available in 79 patients (87%), 25 from the hospital that favored biopsy and 54 from the hospital that favored early resection. Among living patients there was no difference in EQ-5D index scores (p = 0.426). When imputing scores defined as death (zero) in patients dead at follow-up, a clinically relevant difference in EQ-5D score was observed in favor of early resections (p = 0.022, mean difference 0.16, 95% confidence interval 0.02–0.29). In EORTC questionnaires pain, depression and concern about disruption in family life were more common with a strategy of initial biopsy only (p = 0.043, p = 0.032 and p = 0.045 respectively). In long-term survivors an aggressive surgical approach using intraoperative 3D ultrasound image guidance in LGG does not lower HRQL compared to a more conservative surgical approach. This finding further weakens a possible role for watchful waiting in LGG.     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

目的 评价高场强术中磁共振(iMRI)对脑胶质瘤手术切除程度及手术策略的影响.方法 解放军总医院神经外科自2009年10月至2010年6月将高场强iMRI系统应用于胶质瘤切除术患者106例,术前了解术者的切除意图(全切、次全切、大部切除),术前1 d患者常规行MRI扫描,应用影像数据和软件计算术前肿瘤体积,术中常规使用神经导航手术,依据术者的需求采集影像.必要时行iMRI扫描计算术中残余肿瘤体积和肿瘤体积切除百分比,分析使用iMRI对肿瘤切除程度、手术策略的影响.结果 术前计划全切48例,次全切41例,大部切除17例.术中第一次扫描示42例(39.6%)完全切除,64例(60.4%)仍有残留,其中25例由于肿瘤与重要功能区或重要传导束紧邻而未作进一步切除,其余39例(36.8%)改进手术策略,标记出残留肿瘤后进一步手术,25例(23.6%)胶质瘤最终全切除,肿瘤体积切除百分比由(76.5±20.5)%提高到(94.2±8.7)%,差异有统计学意义(U=2.000,P=0.000);最终实际全切67例,次全切25例,大部切除14例,全切率有所提高.106例患者平均肿瘤体积切除百分比由第一次扫描时的(86.3±20.2)%提高到最终扫描时的(93.6±12.4)%,差异有统计学意义(U=4.000,p=0.000).结论 高场强iMRI的应用可显著提高脑胶质瘤的切除程度,改进手术策略.

Abstract：

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

边缘系统胶质瘤的临床病理特征及手术治疗

目的 对边缘系统胶质瘤的临床特征，手术切除及效果进行分析。方法 对1997年10月至2000年4月进行切除的19例边缘系统胶质瘤病人的临床表现，病理类型，影像学特征，手术及预后进行回顾性分析。结果 19例病人均进行了肿瘤切除。14例全切，5例次全切，术后除各有2例病人出现暂时运动性失语和对侧肢体偏瘫外，均恢复良好，无严重的手术并发症及手术死亡。结论 边缘系统胶质瘤源于原始皮质，MRI能清楚地显示肿瘤的大小，部位，范围和界限，可以进行广泛性肿瘤切除而不损伤或很少损伤重要结构。     

Craniopharyngioma: the pendulum of surgical management

Background

For a long time, craniopharyngiomas have been considered surgically attractive tumours. The fact that they are rare, histologically benign, and located in a challenging (but considered accessible) area made them worthy surgical prizes.

Methods

As we have saved vision and “cured” many of these tumours, the insidious and devastating effects on quality of life for these children has become evident.

Discussion

The state-of-the-art in the surgical management of craniopharyngioma is now turning to multi-modality treatment strategies (combination surgery and radiotherapy) aiming to limit morbidity. Questions remain—what factors influence our surgical decision making? Do we understand the long-term effects of the radiotherapy now being employed? We review a series of craniopharyngiomas looking for variables that correlated with outcome as perceived in terms of quality of life and we review briefly the history of craniopharyngioma surgery and the relevant literature.     

B超实时引导在低级别胶质瘤切除术中的应用

目的 探讨B超实时引导在低级别胶质瘤切除术中的应用价值.方法 回顾性分析2012年6月至2016年6月佳木斯市中心医院神经外科收治的72例低级别胶质瘤患者的临床资料.36例行B超实时引导下肿瘤切除术（观察组）,36例行常规术前定位下肿瘤切除术（对照组）.比较两组的手术情况、肿瘤定位准确率、手术全切除率、日常生活活动能力（ADL）量表评分以及Karnofsky功能状态评分（KPS）.结果 观察组的手术时间少于对照组（P＜0.01）.观察组的肿瘤定位准确率、手术全切除率均高于对照组（均P＜0.01）.随访6个月时观察组的ADL评分较治疗前改善[分别为（84.7±8.8）分和（66.4±7.6）分,P ＜0.001],而对照组治疗前、治疗后6个月的ADL评分差异无统计学意义（P＞0.05）.随访6个月时,观察组和对照组的KPS评分[分别为（81.1±7.8）分和（71.4±9.9）分]均较治疗前[分别为（58.1±8.2）分和（56.9±9.2）分]改善（均P＜0.001）,且观察组的改善更为明显（P＜0.01）.结论 B超实时引导应用于低级别胶质瘤切除术中可获得良好的临床效果,可显著缩短手术时间,提高患者的生命质量.     

An analysis of related factors of surgical results for patients with craniopharyngiomas

Objective

The objective of this study was to retrospectively review the surgical results following gross total resection and partial resection with or without radiotherapy for craniopharyngiomas and analyze the related factors of surgical results.

Methods

From 1994 to 2009, 214 patients underwent 219 procedures for craniopharyngiomas. We retrospectively reviewed the pre- and postoperative data of patients, reported the perioperative and long-term surgical results and analyzed the influencing factors and the relationship between hypothalamic involvement and postoperative quality of life.

Results

Gross total resection was achieved in 154 procedures (70.3%). Perioperative mortality was 5%. Perioperative hyperpyrexia was the most significant risk factor for perioperative mortality. A total of 151 patients were followed from 6 months to 190 months. There were significant differences in recurrence rate and overall survival between gross total resection and limited resection (P < 0.05). There was significant difference in recurrence rate between limited resection and limited resection with radiotherapy (P < 0.01), but it did not reach statistical difference between gross total resection and gross total resection with radiotherapy. The factors strongly influencing overall survival include old patients, partial resection and recurrent tumors. The preoperative hypothalamic involvement negatively correlates with the postoperative quality of life in patients with craniopharyngiomas.

Conclusion

The preoperative CT/MR imaging provides clues of the relationship between tumor and surrounding structures. Gross total resection should be achieved in the treatment of craniopharyngiomas on the condition that hypothalamus is preserved. The patients who undergo limited resection should receive conventional radiotherapy or gamma knife surgery.     

伽玛刀治疗脑胶质细胞瘤的临床初步观察

目的 评价伽玛刀对脑内胶质细胞瘤的治疗效果。方法 自1996年11月至1999年12月对57例病理诊断明确的脑胶质瘤患者进行了伽玛刀治疗，其中男35例，女22例，年龄7－68岁，平均30.8岁。病变位于大脑半球27例，丘脑及基底节区22例，脑干2例，小脑2例。病理诊断：星形细胞瘤Ⅰ级7例，Ⅱ级5例，Ⅰ－Ⅱ18例，少枝胶质瘤4例，室管膜瘤2例，星形细胞瘤Ⅲ级2例，Ⅳ级2例，Ⅲ－Ⅳ级13例，胶质母细胞瘤4例。周边剂量为12－22Gy，平均为16.5Gy。结果 随访时间为6至42个月，平均为23个月。36例低恶度胶质瘤的影像学复查结果：显效6例；有效14例；微效5例；无变化6例；恶化5例。有效率为55．6％。21例高恶度胶质瘤中2－3个月及远期影像有效率分别为66．7％和23．8％。6，12，24，36个月的存活率分别为：95．2％（20／21）；81.0%(17/21)；47．1％9（8／17）和33.3%(3/9)。15例病人（26.3%)于治疗后12个月内出现放射性水肿。结论 伽玛刀对体积较小，边界相对较清的低恶度胶质瘤的治疗是有效的，对高恶度胶质瘤在短期内可有效地杀死靶区内肿瘤细胞并延缓肿瘤的生长，但并不能有效地控制周边肿瘤细胞生长和复发。     

下丘脑错构瘤40例临床分析

目的 总结下丘脑错构瘤的诊断和治疗。方法 40例下丘脑错构瘤，男：女＝1.35:1；发病年龄为2个月至51岁，中位数为12.5个月。15岁以下儿童32例（80％），成人（18岁以上）4例（10％）。其临床主要特点为痴笑样癫痫和性早熟，少数还有其它类型癫痫、智力低下或合并先天畸形；其中单纯性早熟者19例（48％），性早熟合并癫痫者14例（35％），单纯癫痫者7例（18％）。CT、MRI显示脚间池或垂体柄后上方有等信号（等密度）病变，注药无强化，手术治疗27例，除1例采用经纵板入路外，均采用经翼点入路切除错构瘤；γ刀治疗8例；药物治疗1例。结果 全切14例（52％），其中10例为单纯性早熟者，均治愈；大部切除13例，症状明显好转，手术有效率为975；单纯γ刀治疗的5例中有效1例，余4例观察时间尚短，而难以判断；药物治疗性早熟有效，但对痴笑样癫痫及其它类型癫痫无效。结论 下丘脑错构瘤首选治疗为手术切除。     

伽玛刀治疗脑胶质细胞瘤的临床初步报告

目的：评价伽玛刀治疗对脑内胶质细胞瘤的疗效。方法：57例病理诊断明确的脑胶质瘤患者进行了伽玛刀治疗,其中男35例,女22例,年龄7－68岁,平均30．8岁,病变位于大脑半球27例,丘脑及基底节区22例,脑干2例,小脑2例,病理诊断：星形细胞瘤Ⅰ级7例,Ⅱ级5例,1Ⅰ－Ⅱ级18例,少枝胶质瘤4例,室管膜瘤2例,星形细胞瘤Ⅲ级2例,Ⅳ级2例,Ⅲ－Ⅳ级13例,胶质母细胞瘤4例。周边剂量为12－22Gy,平均为16．5Gy。结果：随访时间为6至42个月,平均为23个月。36例低恶度胶质瘤的影像学复查结果：显效6例（16．7％）;有效14例（38．9％）,微效5例（13．9％）,无变化6例（16．7％）;恶化5例（13．9％）,有效率为55．6％。21例高恶度胶质瘤中2－3个月及远期影像学有效率分别为66．7％和23．8％。6,12,24,36个月的存活率分别为95．2％（20／21）;81．0％（17／21）;47．1％（8／17）和33．3％（3／9）。15例病人（26．3％）于治疗后12个月内出现放射性水肿。结论：伽玛刀对体积较小,边界相对较清的低恶度胶质瘤的治疗是有效的,对高恶度胶质瘤在短期内可有效地杀死靶区内肿瘤细胞并延缓肿瘤的生长,但并不能有效地控制周边肿瘤细胞生长和复发。     

Clinical attributes and surgical outcomes of angiocentric gliomas

Angiocentric gliomas (AG) are exceedingly rare low-grade neoplasms which often present in the form of intractable epilepsy within younger patients. The current study extensively reviews all reported cases which were pathologically verified as AG in the literature to analyze clinical attributes and surgical outcomes of this neoplasm. There were 88 patients with AG reported in the literature consisting mostly of pediatric cases. The sex distribution consisted of 45 males and 36 females with the remaining seven cases not documenting sex. The average age of initial diagnosis was 16 years with almost half of all diagnosed patients being within the first decade of life. In cases where extent of resection was reported, gross total resection (GTR) was achieved in 54 patients, subtotal resection (STR) in 16, and biopsy only in three. Post-operative complications were transient and only occurred in three patients with no reports of death following surgery. Only five cases reported tumor recurrence on follow-up. Eight patients had seizure recurrence post-operatively and GTR offered improved rates of seizure control when compared to STR (p = 0.0005). Nearly half of the cases of AG are diagnosed within the first decade of life and they usually manifest with intractable seizures. GTR appears to offer better seizure control in the post-operative period. Surgical resection is the mainstay therapy for AG as post-operative complications and tumor recurrence remain uncommon. Since the number of reported cases is limited, future studies with longer follow-up periods will help elaborate more long-term outcomes.