丘脑基底节肿瘤的外科治疗

作者自1983年至1993年共手术治疗丘脑基底节肿瘤46例。其中,姑息性手术2例,活检12例,常规开颅切除肿瘤20例,立体定向手术切除12例,术后症状改善25例,无变化12例,恶化8例,死亡1例。主张无颅高压的丘脑基底节肿瘤首选定向活检与放射治疗;有颅高压者须切除肿瘤,其中立体定向手术切除肿瘤术后患者有较高的生存质量。     

丘脑基底节肿瘤的外科治疗

１９８３～１９９３年共手术治疗丘脑基底节肿瘤４６例。其中，姑息性手术２例，活检１２例，常规开颅切除肿瘤２０例，立体定向手术切除肿瘤１２例。术后症状改善２５例，无变化１２例，恶化８例，死亡１例。主张无颅内压增高的丘脑基底节肿瘤首选定向活检与放射治疗；有颅内压增高者须切除肿瘤，其中立体定向手术切除肿瘤术后患者有较高的生存质量。     

外科治疗丘脑基底节肿瘤14例报告

目的　探讨丘脑基底节肿瘤的外科治疗方法。方法　回顾性总结 14例丘脑基底节肿瘤的临床表现、影像学特征、病理及治疗方法。结果　 14例患者中手术 12例 ,立体定向活检 2例。治疗后症状改善 11例 ,无改善 1例 ,恶化 1例 ,死亡 1例。结论　丘脑基底节肿瘤外科治疗困难较大 ,需根据临床表现及影像学特征早诊断。通过显微外科手术争取切除肿瘤、改善脑脊液循环、缓解症状、明确病理诊断 ,为放疗、化疗创造条件     

外科治疗丘脑基底节肿瘤14例报告

目的 探讨丘脑基底节肿瘤的外科治疗方法。方法 回顾性总结14例丘脑基底节肿瘤的临床表现、影像学特征、病理及治疗方法。结果 14例患者中手术12例，立体定向活检2例。治疗后症状改善11例，无改善1例，恶化1例，死亡1例。结论 丘脑基底节肿瘤外科治疗困难较大，需根据临床表现及影像学特征早诊断。通过显微外科手术争取切除肿瘤、改善脑脊液循环、缓解症状、明确病理诊断，为放疗、化疗创造条件。     

101例基底节和丘脑动静脉畸形的治疗和结果

由于位在基底节和丘脑的动静脉畸形(AVM)治疗上的困难,为此作者进行了回顾性研究,以确定对这些病变的最佳治疗方案 作者对1971年到1995年期间101例AVM病人的治疗结果进行了复习。行保守治疗的15例病人,出血率为71.4％(年出血率为11.4％)。在平均6.6年的随访期病残率和死亡率分别为7.1％和42.9％。15例病人行显微外科治疗,全部切除病变,无手术死亡 但3例病人(20％)发生永久性运动功能恶化。手术后的病残与脑AVM的部位、术前运动功能情况密切相关。位在豆状核无运动功能减退的AVM病人,术后运动功能减退明显     

基底节和丘脑生殖细胞瘤

颅内原发生殖细胞瘤好发于松果体区和鞍区 ,而发生于基底节和丘脑区者少见 ,该病基本上只发生在男孩 ,除偏瘫为主要表现外 ,还可以有智力下降和语言障碍等。MR和CT示病变虽然体积比较大 ,但是病变周围水肿并不严重 ;边界不规则 ;可以有轻到中度的不均匀强化 ,可合并囊变 ,钙化 ,出血 ,患侧大脑半球萎缩等。同颅内其它部位生殖细胞瘤一样对放疗十分敏感 ,基本上可以达到治愈 ;此外可以应用联合化疗 ;手术和活检对明确诊断有帮助     

基底节和丘脑生殖细胞瘤的外科诊治

目的　介绍基底节和丘脑区生殖细胞瘤的外科诊治特点。方法　回顾分析我科 1996至 2 0 0 0年间 14例基底节和丘脑区生殖细胞瘤的临床资料。 14例中女性仅 1例。临床表现以肢体运动和感觉障碍为主。MR和CT显示病变周围无或轻度水肿 ,可伴囊变、钙化或出血。选择额叶皮质侧脑室或经侧裂入路 ,行显微神经外科肿瘤切除术。结果　肿瘤全切除 9例 ,近全切除 4例 ,部分切除 1例。术后单纯行放疗 8例 ,单纯行化疗 1例 ,放疗加化疗 2例。 11例随访 10～ 5 7个月 ,除 1例死于化疗并发症 ,余恢复良好。结论　基底节和丘脑生殖细胞瘤绝大多数发生在男性少年儿童。确诊较难 ,对于确诊病人 ,手术治疗效果虽有提高 ,但仍应慎重 ,对于怀疑该病时可行试验性放疗。该病预后良好。     

丘脑肿瘤的显微外科治疗

目的总结丘脑肿瘤的临床特点,探讨其显微外科治疗方法。方法回顾性分析21例丘脑肿瘤患者手术入路的选择、手术技巧以及术后并发症。本组经脑室前角入路9例,经侧脑室后角入路7例,经三角区入路2例,经颞后皮质入路1例,经胼胝体侧脑室入路2例。结果21例肿瘤中全切除15例,大部分切除6例。手术后2例昏迷,7例出现神志淡漠;5例肢体运动障碍加重,仅2例有不同程度的恢复;术前8例脑积水患者中,术后5例得到改善,另3例行脑室-腹腔分流术。结论丘脑肿瘤手术仍是神经外科高风险手术,显微外科手术切除是有效的治疗方法。     

双侧基底节肿瘤误诊为特发性基底节钙化附一例报告

本文报告一例经病理证实的双侧大脑基底节原发性生殖细胞瘤误诊为Fahr综合征的病例。 病历摘要 患者男性,9岁,18个月前感右手力弱,写字、持物不稳。病后两个月感右下肢无力并有语言减少,半年后右侧肢体无力明显加重,同时左侧肢体亦感无力,语言明显减少。7个月前病情加重,不能讲话。近2个月已不能行走而住院治疗。     

显微外科治疗丘脑肿瘤32例临床分析

目的探讨显微外科治疗丘脑肿瘤的疗效,并总结其临床特点。方法我院2009-01-2010-11收治32例丘脑肿瘤患者,采用显微外科治疗,探讨其治疗特点及疗效,总结显微外科治疗丘脑肿瘤的临床应用价值。结果 15例患者（46.9%）行肿瘤全切术,12例（37.5%）行大部分切除术,5例（15.6%）行部分切除术。行显微外科治疗后,患者的短期症状及神经功能明显改善9例（28.1%）,改善11例（34.3%）,无改善9例（28.1%）,转为恶化2例（6.2%）,死亡1例（3.1%）。结论丘脑肿瘤具有病程长的特点,多为恶性肿瘤,儿童与青年患病较为常见,且肿瘤位于脑深部,手术较为困难,故此采取显微外科治疗,临床疗效较显著,值得推广应用。     

丘脑及基底节区生殖细胞瘤

报告５例经手术及病理证实的丘脑或基底节区生殖细胞瘤的临床及影像学特点。其发生率占同期所有颅内生殖细胞瘤的６％。５例均为男性。主要临床症状为偏侧肢体无力，两例检查发现精神异常及性早熟。与松果体区及鞍上区生殖细胞瘤的ＣＴ及ＭＲ表现相比，本组丘脑或基底节区生殖细胞瘤的主要特点在瘤体的大小及密度信号、瘤内出血及相邻结构的变化几方面。     

The germinomas arising from the basal ganglia and thalamus

Objective To introduce the features of germinomas arising from the basal ganglia (BG) and thalamus. Method Retrospective analysis was done with the clinical cases of germinomas in BG and thalamus from 1996 to 2000. The data included the symptoms, signs, neuroimaging findings, treatment, and outcomes. Result Fourteen cases were included, only one female was included. The main symptoms are disorder of numbness and weakness in limbs. Neuroimaging showed no or mild peritumor high signal in T2 weighted imaging of magnetic resonance, accompanied with cyst, calcification or bleeding. Total gross resection was obtained in nine cases, subtotal resection in four. Follow-up data were available in 11 cases with average of 56 months. Eight cases underwent only postoperative radiotherapy, one underwent only chemotherapy, and two underwent both. One case died of complication 6 months after chemotherapy, the rest lived good life. Conclusion Germinoma in BG and thalamus predominate in a boy. The neuroimaging features are very informative for diagnosis. Surgical resection should not be the first choice although it is has lesser complications. The long-term outcome is favorable.     

Outcomes of basal ganglia and thalamic cavernous malformation surgery: A meta-analysis

Surgical resection of basal ganglia (BG) and thalamic cavernous malformations (CMs) has not yet become standardized in the field of neurosurgery due to the eloquent location of these lesions and the relative paucity of literature on the subject. This review presents a consolidation of the available literature on outcomes and complication rates after surgical resection of these lesions. A systematic literature review was performed via PubMed database for articles published between 1985 and 2019. Studies comprising ≥2 patients receiving surgery for BG or thalamic CMs with available follow-up data were included. Pooled data included patient demographics, CM preoperative characteristics, and surgical outcomes Twenty studies comprising 227 patients were included for analysis. Complete resection was achieved in 94.7% (fixed-effects pooled estimate [FE]: 94.9%[91.0%–97.8%]; random-effects pooled estimate [RE]: 90.0%[79.8%–96.9%]), and hemorrhage of incompletely resected CMs occurred in 50% (FE: 55.9%[25.9%–83.6%]; RE: 55.9%[25.9%–83.6%]) of patients. Early morbidity was observed in 24.0% (FE: 24.9%[17.8%–32.6%]; RE: 24.9%[17.8%–32.6%]). At final follow-up, 67.3% (FE: 67.7%[58.8%–76.0%]; RE: 67.8%[52.2%–81.6%]) and 20.6% (FE: 20.6%[13.6%–28.6%]; RE: 20.9%[9.8%–34.9%]) had improvement and stability of preoperative symptoms, respectively. Mortality rate was 1.3% (FE: 2.3%[0.6%–5.1%]; RE: 2.3%[0.6%–5.1%]). Therefore, high cure rates with low rates of postoperative morbidity can be achieved in BG or thalamic CM surgery. Most patients had improved neurological function at final follow-up. Complete resection should be attempted to reduce rates of repeat hemorrhage.     

儿童松果体区肿瘤的治疗策略

目的 探讨儿童松果体区肿瘤的临床特点与治疗策略.方法 回顾性分析上海华山医院治疗的70例经病理证实的儿童松果体区肿瘤.根据手术方式和术后表现进行分析.结果 男53例,女17例,年龄6 ～16岁.经病理证实生殖细胞肿瘤(包括生殖细胞瘤、畸胎瘤及其他恶性非生殖细胞瘤性生殖细胞肿瘤)47例,松果体细胞瘤6例,松果体母细胞瘤3例,星形细胞瘤3例,毛细胞型星形细胞瘤4例,其他类型肿瘤7例.所有病例均接受手术治疗,70例中,经小脑幕下小脑上入路37例,经枕下经小脑幕入路26例,经胼胝体-穹窿间入路4例,经胼胝体后部入路2例,颞部-侧脑室三角部入路1例.肿瘤全切除36例,次全切除18例,大部分切除16例.病理证实为恶性的病变术后行放疗和(或)化疗,9例术后并发脑积水行分流术,共随访到58例(83％),总的5年生存率为66％,术后KPS评分大于80分者53例(91％).结论 对于儿童松果体区肿瘤,影像学检查缺乏明确特征,病理检查是诊断金标准,手术治疗应为首选.明确病理后应实施个体化的治疗方案,最大限度地提高远期生存率.     

Germ cell tumors of the thalamus and the basal ganglia

Two cases of germ cell tumors (GCTs) of the basal ganglia are presented and 40 previously reported cases are reviewed. The incidence of GCTs of the basal ganglia and thalamus was estimated as less than 14% of all intracranial GCTs. All patients except for two (95%) were male, aged 7–19 years. The clinical course was usually slow. The major symptoms were hemiparesis, mental deterioration such as dementia or character change, precocious puberty, diabetes insipidus, oculomotor palsy, speech disturbance, and hemianopsia. Signs of intracranial hypertension did not occur until the late stages of the disease. The plain CT finding was characterized by an irregularly defined, slightly high-density area frequently accompanied by central low-density areas without significant mass effect. The tumors showed mild to moderate and nonhomogeneous contrast enhancement. An ipsilateral cerebral hemiatrophy was often found. MR images demonstrated the corresponding findings. GCTs of the basal ganglia had a high possibility of containing components other than germinoma such as choriocarcinoma, endodermal sinus tumor, and embryonal carcinoma. Thus, tumor markers in the serum, CSF, or cyst fluid were frequently positive. With recent refinement of microsurgical techniques as well as immunohistochemical study and measurements of tumor markers of serum, CSF, and cyst fluid, major resections of tumor, accurate pretreatment histologic diagnosis, and early determination of the specific types of this tumor appear to be readily possible. This is essential for effective treatment of patients not only with radiosensitive germinoma, but also those with radioinsensitive nongerminoma variants and a combination of them located in this region.     

基底节生殖细胞瘤的临床和影像学分析

目的分析伴脑干萎缩的基底节生殖细胞瘤临床特点及影像学改变，以提高对此病的认识。方法结合文献分析7例基底节生殖细胞瘤患者的临床和影像学特征。结果7例患者均为年轻男性，主要表现为缓慢进展的轻偏瘫；影像学显示肿瘤主要位于基底节，MRIT。加权像上呈低或等低混杂信号，T2加权像上呈高或等高混杂信号，伴有同侧大脑半球或脑干萎缩。结论基底节生殖细胞瘤临床及影像学缺乏特异性；年轻患者出现缓慢进行性偏瘫，伴有病变同侧大脑偏侧萎缩或／和大脑脚萎缩的基底节病变应高度怀疑基底节生殖细胞瘤。     

28例基底节区生殖细胞瘤诊断性放疗的评价

目的分析丘脑及基底节区生殖细胞瘤的临床、影像学特点,诊断性放疗及小剂量局部放疗加静脉化疗的治疗效果.方法回顾性分析了28例局限于丘脑及基底节区经诊断性放疗证实的生殖细胞瘤的临床特点和疗效.患者肿瘤局部照射剂量为35～40Gy/3-4周.放疗后1个月行VMPP化疗两疗程,每间隔6个月复查MRI,随访时间1-3.5年.结果所有病例均无瘤生存,无复发,未见放射性损伤.但患者肿瘤对侧的肢体运动障碍无明显改善.结论丘脑及基底节区生殖细胞瘤有独特的影像学特点,通过诊断性放疗可以进一步确诊.     

外伤性基底节区血肿的诊断和治疗

目的探讨外伤性基底节区血肿的发病机制、临床特点、诊断与鉴别诊断、治疗和结果。方法回顾性分析40例外伤性基底节区血肿病人的临床资料。结果本组外伤性基底节区血肿占闭合性颅脑创伤的3．2％。多为车祸伤，年轻人多见，大多发生于对冲部位。伤后早期即出现偏瘫而意识障碍较轻，且合并弥漫性轴索损伤的发生率较高。动态CT扫描是诊断外伤性基底节区血肿的最好检查方法。手术治疗10例，保守治疗30例，在伤后6个月根据GOS评分：良好10例，中残17例，重残2例，死亡11例。结论CT是外伤性基底节区血肿的首选检查方法，动态CT扫描有利于发现迟发性外伤性基底节区血肿。外伤性基底节区血肿发病率较低而致残率较高，外伤性基底节区血肿只要早期诊断，积极而恰当的治疗，大部分病人预后较好。     

Neuronal activity in the basal ganglia and thalamus in patients with dystonia.

OBJECTIVE: To explore the role of abnormal neuronal activity in the basal ganglia and thalamus in the generation of dystonia. METHODS: Microelectrode recording was performed in the globus pallidus internus (GPi), ventral thalamic nuclear group ventral oral posterior/ventral intermediate, Vop/Vim) and subthalamic nucleus (STN) in patients with primary dystonia (n=11) or secondary dystonia (n=9) during surgery. Electromyogram (EMG) was simultaneously recorded in selected muscle groups. Single unit analysis and cross-correlations were carried out. RESULTS: Three hundred and sixty-seven neurons were obtained from 29 trajectories (GPi: 13; Vop/Vim: 12; STN: 4), 87% exhibited altered neuronal activity including grouped discharges in GPi (n=79) and STN (n=37), long-lasting neuronal activity (n=70) and rapid neuronal discharge (n=86) in Vop/Vim. There were neurons in Vop, GPi and STN firing at the same frequency as EMG during dystonia (mean: 0.39 Hz, range 0.12-0.84 Hz). Significant correlations between neuronal activity and EMG at the frequency of dystonia were obtained (GPi: r2=0.7 (n=31), Vop/Vim: r2=0.64 (n=18) and STN: r2=0.86 (n=17)). CONCLUSIONS: Consistent with previous findings of abnormalities observed in Vop/VIM and GPi in relation to dystonia, the present data further show that the altered activity in GPi, specifically in dorsal subregions of GPi, Vop/Vim and STN is likely to be directly involved in the production of dystonic movement. Dystonia-related neuronal activity observed in motor thalamus and basal ganglia nuclei of GPi and STN indicates a critical role of their interactions affecting both indirect and direct pathways in the development of either generalized or focal dystonia. SIGNIFICANCE: These data support a central role of the basal ganglia in producing dystonic movements.     

Cholinergic systems in the rat brain: III. Projections from the pontomesencephalic tegmentum to the thalamus, tectum, basal ganglia, and basal forebrain

The ascending cholinergic projections of the pedunculopontine and dorsolateral tegmental nuclei, referred to collectively as the pontomesencephalotegmental (PMT) cholinergic complex, were investigated by use of fluorescent tracer histology in combination with choline-O-acetyltransferase (ChAT) immunohistochemistry and acetylcholinesterase (AChE) pharmacohistochemistry. Propidium iodide, true blue, or Evans blue was infused into the anterior, reticular, mediodorsal, central medial, and posterior nuclear areas of the thalamus; the habenula; lateral geniculate; superior colliculus; pretectal/parafascicular area; subthalamic nucleus; caudate-putamen complex; globus pallidus; entopeduncular nucleus; substantia nigra; medial septal nucleus/vertical limb of the diagonal band area; magnocellular preoptic/ventral pallidal area; and lateral hypothalamus. In some animals, separate injections of propidium iodide and true blue were made into two different regions in the same rat brain, usually a dorsal and a ventral target, in order to assess collateralization patterns. Retrogradely transported fluorescent labels and ChAT and/or AChE were analyzed microscopically on the same brain section. All of the above-delimited targets were found to receive cholinergic input from the PMT cholinergic complex, but some regions were preferentially innervated by either the pedunculopontine or dorsolateral tegmental nucleus. The former subdivision of the PMT cholinergic complex projected selectively to extrapyramidal structures and the superior colliculus, whereas the dorsolateral tegmental nucleus was observed to provide cholinergic input preferentially to anterior thalamic regions and rostral portions of the basal forebrain. The PMT cholinergic neurons showed a tendency to collateralize extensively.