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。     

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。     

颅内毛细胞型星形细胞瘤的诊治及预后

目的探讨颅内毛细胞型星形细胞瘤的病理学特点、临床特点、影像学表现和治疗经验。方法回顾性分析南京军区总医院神经外科2002年6月至2006年6月四年间20例经手术病理证实的毛细胞型星形细胞瘤临床资料。分析其影像学特点及术中所见和预后情况。结果20例肿瘤均接受显微外科手术,根据肿瘤所在部位采取不同手术入路。16例全切,4例大部分切除,4例均位于视交叉或下丘脑部,与周边重要神经结构粘连较紧。结论颅内毛细胞型星形细胞瘤为良性肿瘤,显微手术全切预后良好,对于未全切病例术后行恰当的放疗或化疗也能获得理想效果。     

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。     

儿童小脑星形细胞瘤影像学表现和手术治疗

目的　探讨手术切除儿童小脑星形细胞瘤的方法。方法　根据影像学改变将小脑星形细胞瘤分成实性肿瘤、囊在瘤内、瘤在囊内 3种类型。根据肿瘤部位采取枕下正中入路、正中外拐入路、CPA拐形入路。结果　手术治疗 63例 ,实性肿瘤 2 8/ 2 9全切除 ,瘤在囊内肿瘤 15 / 15全切除 ,囊在瘤内肿瘤 18/ 19全切除。结论　儿童小脑星形细胞瘤总的全切除率 96 8% ,对实性肿瘤和囊在瘤内型肿瘤术后应常规做放疗。     

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。     

老年小脑毛细胞型星形细胞瘤伴卒中1例

目的总结1例老年小脑毛细胞型星形细胞瘤(PA)伴卒中病例的诊治经验。方法回顾性分析1例老年小脑PA伴卒中病人的临床资料,采用枕下后正中入路开颅,显微外科手术全切除肿瘤并清除出血。结果术后病理证实为PA。术后MRI示:肿瘤全切除。术后3个月随访:病人恢复好,未见复发迹象,继续随访观察。结论老年小脑PA伴卒中病例非常罕见,头颅MRI是其主要检查方法,利用显微神经外科技术全切除肿瘤并清除出血可获得较好预后。     

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。     

儿童第四脑室肿瘤的显微外科治疗(附43例报告)

目的 探讨儿童第四脑室常见肿瘤的诊断和显微手术技巧.方法 回顾性分析2006~2010年手术治疗的43例儿童第四脑室肿瘤患者的临床表现与影像学等临床资料;根据肿瘤与小脑蚓部和第四脑室的关系,设计个体化手术入路切除肿瘤.结果 肿瘤全切除38例,次全切5例(为与第四脑室底粘连紧密者).绝大多数病例无明显并发症或并发症较轻,经治疗后好转.病理结果示髓母细胞瘤27例,室管膜瘤8例,星形细胞瘤7例(其中毛细胞型3例),神经细胞瘤(交界性)1例.髓母细胞及WHOⅢ级的室管膜瘤术后进行了全脑和脊髓放疗,次全切的室管膜瘤和星形细胞瘤进行了局部放疗.结论 儿童第四脑室肿瘤以髓母细胞瘤最多见,其次是室管膜瘤和星形细胞瘤;正确的入路选择和手术技巧是取得良好疗效、减少并发症的关键.     

Radiologically typical pilocytic astrocytoma with histopathological signs of atypia

Pilocytic astrocytoma (PCA) is the most common CNS tumor in primary school-aged children. Herein, we report the case of a 7-month-old female child with a large cerebellar hypodense tumor on computer tomography occupying nearly the whole cerebellar hemisphere. Magnetic resonance imaging revealed characteristic features of a PCA, depicting a mass with hyperintense solid and cystic areas on T2-weighted images and with marked solid and ring-like enhancement pattern. Histopathological and immunohistochemical analysis showed partially typical features of a PCA, but also atypical features such as a high proliferation rate, hypercellularity, and focally diffuse infiltration pattern were present. However, definite signs of transformation to an anaplastic PCA were not observed. We therefore classified the tumor as pilocytic astrocytoma with signs of atypia instead of simple WHO grade I pilocytic astrocytoma. The case illustrates that neuroimaging features may give very important clues for the definite diagnosis in histopathologically atypical PCA.     

An elderly case of malignant small cell glioma with hemorrhage coexistent with a calcified pilocytic astrocytoma component in the cerebellar hemisphere

Pilocytic astrocytoma is a less aggressive form of glial tumor that commonly occurs in the pediatric population, and its malignant transformation is extremely rare. Here, we report an elderly case of malignant small cell glioma with hemorrhage coexistent with a calcified pilocytic astrocytoma component. An 80‐year‐old male was found to have a right cerebellar non‐enhanced tumor with hematoma adjoining a calcified nodule. The lesion was surgically removed, and a histological examination verified that the tumor was a malignant small cell glioma with hemorrhagic change and the calcified nodule showed features of pilocytic astrocytoma. Genetic analyses revealed no glioma‐relevant genetic alterations such as IDH and BRAF mutations. Although calcification is generally observed in slowly growing gliomas, the aggressive clinical course of calcified cerebellar pilocytic astrocytoma has been previously reported. Our extremely rare case shows that careful follow‐up is necessary even for calcified pilocytic astrocytomas.     

儿童第四脑室-小脑脚-脑干区肿瘤的手术治疗

目的 研究第四脑室-小脑脚-脑干区肿瘤的形态学特点，以及安全地切除此部位肿瘤的手术方法。方法 儿童（15岁以下）第四脑室-小脑脚-脑干区肿瘤（室管膜瘤和星形细胞瘤）23例。术前头颅MRI证实瘤体起源于小脑脚或侧隐窝，分别向第四脑室，脑干，CPA和斜坡生长。采用枕下正中外侧拐入路，术中分区域切除肿瘤，结果 全切除肿瘤12例，近全切除9例，大部切除2例，无手术死亡，术后病理证实室管膜瘤13例，恶性室管膜瘤2例，星形细胞瘤8例。结论 起源于小脑脚或侧隐窝的肿瘤，以脑干为中心呈半弧形生长，肿瘤侵袭范围包括第四脑室，小脑脚，脑干，CPA和斜坡，合适的手术入路和术中分区域切除肿瘤的技术，可以做到安全地全切除和/或近全切除肿瘤。     

Hemosiderin pigmentation of tumour cells in cerebellar pilocytic astrocytoma associated with post-traumatic hemorrhage in adults

The pilocytic astrocytoma is only rarely associated with gross intratumoral hemorrhage despite rich vasculature and blood vessel changes, accompanied often by perivascular depots of hemosiderin. We report an unusual case of pigmented cerebellar pilocytic astrocytoma presenting with posttraumatic hemorrhage in a 38-year-old man with no history related to the tumor. CT and MRI examination after head injury demonstrated unexpectedly the cystic lesion of 2 cm in diameter in the region of the right cerebellar hemisphere and vermis. The lesion was associated with hematoma and it was surgically removed 3 weeks after trauma. Histopathological examination revealed pilocytic astrocytoma tissue with broad hemorrhagic changes and with an unusual pattern of massive pigmentation of the cytoplasm of pilocytic astrocytes, consistent with hemosiderosis. Positive stains for iron and ferritin and ultrastructural study confirmed deposition of hemosiderin granules in the tumour cells. There was no evidence of melanin or melanosomes. This finding of hemosiderin accumulation in the cytoplasm of neoplastic astroglia seems to be analogous to post-hemorrhagic pigmentation of the normal Bergmann glia and subpial astrocytes. In the literature, the examples of neuroepithelial tumors with hemosiderin pigmentation of tumor cells have been rarely documented. To our knowledge, this is the first reported case of pigmented pilocytic astrocytoma exhibiting extensive intracellular hemosiderin deposition.     

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%.     

Malignant cerebellar astrocytomas in childhood Experience with four cases

The most frequent type of cerebellar astrocytoma in children is the pilocytic variety, for which the treatment of choice and prognosis are now well established. In contrast, an anaplastic lesion in this site is extremely rare. The authors present four cases of high-grade astrocytoma in a cerebellar site. They discuss the best type of treatment for this pathology, with particular reference to postoperative radiotherapy and chemotherapy, in the light of their results. Received: 9 May 1997 Revised: 21 April 1998     

Epilepsy and neuropsychologic deficit in a child with cerebellar astrocytoma

We report the case of a 32-month-old female patient presenting with cerebellar pilocytic astrocytoma with epileptic seizures, psychomotor delay, and severe language delay. Usually, the typical onset of cerebellar tumor is characterized by raised intracranial pressure and cerebellar incoordination. A review of the few cases reported in the literature evidencing epileptic seizures symptomatic of a focal, nondegenerative mass limited to the cerebellum is included. Moreover, a discussion about the cerebellar contribution to nonmotor functions in children is presented, in particular following tumor resection.     

脑毛细胞型星形细胞瘤的MRI诊断特点(附32例报告)

目的探讨脑毛细胞型星形细胞瘤的MRI表现,以提高诊断正确率。方法回顾性分析32例经手术病理证实的毛细胞型星形细胞瘤的临床及MRI特点。结果32例中,71.9%发生于20岁以下青少年人,其中小脑蚓部10例(31.3%),小脑半球9例(28.1%),鞍区7例(21.9%),基底节区和脑干各2例(6.3%),第三脑室内1例(3.1%),右侧颞叶1例(3.1%)。MRI上分四型:单囊型14例(43.8%)、多囊型12例(37.5%);实性型5例(15.6%);完全囊变型1例(3.1%)。肿瘤实性部分平扫T1WI为等或稍低信号,T2WI为等或稍高信号;囊性部分T2WI信号多比脑脊液信号高。增强扫描实性部分明显强化,呈蜂窝状。灶周无水肿28例(87.5%);4例灶周轻微水肿。结论毛细胞型星形细胞瘤的MRI表现有一定的特征性,结合患者的年龄及临床表现可以提高术前诊断率。