立体定向活检联合X-刀治疗颅内难治性囊性肿瘤

目的 探讨颅内难治性囊性肿瘤采用立体定向活检与X-刀相结合治疗的疗效.方法 对8例薄壁囊性脑肿瘤在CT导向立体定向穿刺活检,并抽吸囊液使囊腔缩小,再行X-刀治疗.结果 所有患者均明确了病理类型,肿瘤体积缩小,患者临床症状改善,X-刀治疗效果提高.结论 立体定向手术联合X-刀治疗颅内囊性肿瘤可提高疗效.     

立体定向活检联合陀螺刀治疗囊性脑转移瘤

目的探讨囊性肺癌脑转移瘤采用立体定向活检与陀螺刀相结合治疗的疗效。方法对58例囊性肺癌脑转移瘤在CT导向下立体定向穿刺活检,并穿刺引流囊液使囊腔缩小,再行陀螺刀治疗。结果 58例患者57例明确了病理类型,肿瘤体积缩小,患者临床症状改善,陀螺刀治疗效果提高。结论立体定向手术联合陀螺刀治疗囊性肺癌脑转移瘤具有微创、安全、并发症少、有明显的近期效果和有效的肿瘤控制率等优点。     

伽玛刀联合立体定向手术治疗鼎内囊性肿瘤

目的 探讨立体定向穿刺抽吸手术与伽玛刀联合治疗颅内囊性肿瘤在立体定向放射外科治疗中的作用。方法 分析颅内囊性肿瘤４０例，单纯立体定同液１９例，留置Ｏｍｍａｙａ囊抽液１９例，内窥镜下手术切除肿瘤并排除囊液２例。肿瘤体积缩小后再行立体定向磁共振成像（ＭＲＩ）定位，伽玛刀治疗，并计算抽液前后肿瘤体积的变化，依据Ｌｏｇｉｓｔｉｃ综合方程计算抽液前后风险 变化，将抽液前后的肿瘤体积和风险概率进行配对ｔ检验。     

伽玛刀联合立体定向手术治疗颅内囊性肿瘤

目的探讨立体定向穿刺抽吸手术与伽玛刀联合治疗颅内囊性肿瘤在立体定向放射外科治疗中的作用。方法分析颅内囊性肿瘤40例,单纯立体定向穿刺抽液19例,留置Ommaya囊抽液19例,内窥镜下手术切除肿瘤并排除囊液2例。肿瘤体积缩小后再行立体定向磁共振成像（MRI）定位、伽玛刀治疗,并计算抽液前后肿瘤体积的变化。依据Logistic综合方程计算抽液前后风险概率的变化,将抽液前后的肿瘤体积和风险概率进行配对t检验。结果抽液后瘤囊完全消失,病灶体积明显缩小。抽液前后肿瘤容积和风险概率均显著降低（容积变化：t＝8.108,P＜0．001;风险概率：t＝5．933,P＜0．001）。随访时间6个月～42个月,平均17.5个月。经伽玛刀治疗后,瘤结节消失10例,缩小12例,无变化17例,增大1例。结论颅内囊性肿瘤立体定向穿刺抽液后肿瘤体积缩小,使立体定向放射外科治疗并发症的风险概率显著降低,是联合伽玛刀治疗囊性肿瘤一种有效方法;针对肿瘤病理类型的不同采用伽玛刀放射外科联合单纯穿刺或置管抽取囊液、结合囊内治疗是囊性肿瘤治疗成功的关键。     

颅咽管瘤的微侵袭外科治疗

目的探讨颅咽管瘤的微侵袭治疗方法的选择及并发症。方法46例颅咽管瘤患者,30例行显微手术切除,其中25例行全切除,5例行大部分切除后予r刀治疗;6例行单纯r刀治疗;10例行MRI立体定向囊内放射治疗。结果手术组25例全切除患者,术后21例恢复正常工作,2例需生活照顾,2例死于下丘脑损害;随访2年以上16例,CT或MRI检查未见肿瘤复发。r刀治疗组11例患者临床症状明显改善,随访6～30个月,MRI检查显示4例肿瘤完全消失,5例缩小,2例无变化,无术后并发症。囊腔放疗组10例经手术排除囊液后临床症状明显改善,随访3～30个月,MRI显示3例肿瘤完全消失,7例瘤腔明显缩小,无手术死亡率及严重并发症。结论显微手术全切除颅咽管瘤仍是目前理想的治疗方法,r刀治疗适用实质性和部分实质性,体积较小(<3～4cm)的肿瘤。对囊性体积较大的颅咽管瘤行立体定向囊腔内放疗是一种十分安全有效的方法。     

立体定向手术联合伽玛刀治疗颅内病变

目的 ;探讨立体定向手术联合伽玛刀治疗颅内病变的有效性。方法 1996年11月至2011年1月,立体定向手术联合伽玛刀治疗颅内病变患者399例。其中男237例,女162例;年龄3~75岁,平均38.3岁。结果立体定向活检联合伽玛刀治疗140例,113例获明确的病理结果(95%)。立体定向囊腔抽吸间质内放疗联合伽玛刀治疗颅咽管瘤160例,67例随访60~144个月(平均114个月),肿瘤总体控制率为89.6%。平均生存时间为110±9个月,5、10年的实际生存率分别为88.1%和67.2%。立体定向囊液引流联合伽玛刀治疗囊性脑转移瘤78例,囊液抽吸后体积缩小率为15%~68%(平均52%),肿瘤局部控制率为93.1%,总生存期为16个月,1,2年的生存率分别为57.1%和32.1%。立体定向引导微电极植入联合伽玛刀治疗颞叶内侧癫痫21例。6~36个月(平均15个月)的随访结果显示癫痫的有效控制率为71.4%。共发生与联合治疗有关的并发症19例(4.8%)。结论联合治疗有效可行,可互补两种治疗的优缺点,扩大了治疗范围,提高了治疗效果。     

囊性胶质瘤立体定向活检并内放疗联合γ-刀治疗

目的探讨立体定向穿刺活检加内放疗联合γ-刀治疗囊性胶质瘤的有效性和安全性。方法对24例脑深部及功能区囊性脑胶质瘤行CT导向立体定向穿刺活检,抽吸囊液并置入同位素,2p内放疗后再对胶质瘤实体部分（包括囊壁）行γ-刀治疗,其中13例置入Ommaya管。结果术后24例临床症状均有好转或改善。术后2～3个月行影像学复查,显效17例,有效5例,无效1例,恶化1例,有效率为91．7％（22／24）。术后随访6～36个月,术后6、12、24、36个月生存率分别为95．8％（23／24）、83-3％（20／24）、63．2％（12／19）、46．2％（6／13）。无手术严重并发症发生。结论利用立体定向术加内放疗联合γ-刀治疗脑深部及功能区囊性胶质瘤,具有微创、安全、并发症少、有明显的近期效果和有效的肿瘤控制率等优点。     

立体定向穿刺引流并X-刀治疗颅内囊性转移瘤 (附18例临床分析)

目的探讨立体定向穿刺引流加X刀对囊性脑转移瘤的治疗价值。方法对18例(21个脑囊性转移灶)采用立体定向穿刺引流囊液后再行X刀治疗,随访观察其影像学变化及临床疗效。结果所有病例术后均获得6个月以上随访,肿瘤完全消失10个病灶,明显缩小7个病灶,肿瘤实质增大1个病灶,另3个病灶术后3个月内囊腔再度增大,经抽吸1~3次后稳定,而肿瘤实质部分明显缩小。总体局部肿瘤控制率为95.2%,中位生存期12.3个月。结论立体定向穿刺引流加X刀是囊性脑转移瘤理想的微侵袭治疗组合。     

立体定向内放疗联合γ-刀治疗复发性颅咽管瘤

目的评价立体定向穿刺引流加内放疗结合γ-刀治疗复发性颅咽管瘤的有效性和安全性。方法回顾性分析26例手术后复发性囊实性颅咽管瘤的治疗经验。对16例肿瘤实体部分靠近视神经、视交又及视束者，先行立体定向穿刺抽吸加核素内放疗，再行γ-刀治疗；对10例肿瘤囊性部分靠近视神经、视交又及视束者，先行γ-刀治疗，再行穿刺抽吸加核素内放疗。结果随访6～42个月，平均24．5个月；临床症状和体征消失10例，改善13例，无变化2例，加重1例。影像学检查结果显示病变消失4例，缩小17例，无变化3例。增大2例；有效控制率为92．3％。结论对复发性囊实性颅咽管瘤联合应用立体定向穿刺抽吸引流、^32P内放疗及γ-刀等治疗手段，具有并发症少，复发率及病死率低等优点。     

立体定向显微手术切除脑内小病灶26例分析

目的探讨立体定向引导显微手术切除脑内小病灶及组织活检的方法和优越性。方法应用Leksell-G型脑立体定向仪治疗26例脑重要功能区及脑深部病变患者,行开颅术22例,定向活检2例,脑脓肿抽吸术2例。结果病变性质:胶质瘤14例,动静脉畸形2例,炎性肉芽肿4例,转移瘤1例,海绵状血管瘤2例,脑膜瘤1例和脑脓肿2例。病灶直径为0.6～3.0cm,均在立体定向引导下显微手术行病灶全切除。2例活检为星形细胞瘤(Ⅰ～Ⅱ级),行γ-刀治疗。2例脑脓肿经置管引流,抗炎治疗痊愈。结论立体定向引导的显微手术切除颅内小病灶(直径<3.0cm)及病灶活检是一种定位精确、微创、安全、有效的手术方法。     

内窥镜技术在神经外科手术中的应用研究

目的探讨内窥镜技术在神经外科手术治疗中的价值。方法采用神经内窥镜进行内镜下和内镜控制下以及内镜辅助下的各种神经外科手术122例,包括各种颅内肿瘤切除68例,颅内血肿清除51例,颅内囊肿切除2例,脑积水造瘘1例。结果30例高血压性脑出血患者血肿清除满意,21例慢性硬膜下血肿术后无复发;48例肿瘤全切除,15例次全切除,5例大部切除;1例囊肿全切除,另1例囊肿缩小;1例脑积水患者术后症状明显改善,脑室明显缩小。结论内窥镜技术在微侵袭神经外科手术中具有广泛的临床应用前景。     

老年颅内肿瘤的治疗体会

目的 探讨老年人颅内肿瘤的临床特点和治疗方法。方法 本组65岁以上老年颅内肿瘤126例，分别采用手术，X-刀和非手术治疗。结果 手术治疗65例，良性肿瘤肉眼或显微镜下全切除32例。次全切除6例，恶性肿瘤全切除8例，次全切除10例，大部切除8例。1例囊性颅咽管瘤行立体定向穿刺内放疗。X-刀治疗32例，肿瘤直径在3cm以内，行单次治疗20例；直径在5cm以内。行分次治疗12例，非手术29例。结论 老年人颅内肿瘤有其临床特点，应根据患情况及肿瘤性质，采取不同的治疗方法。     

颅内生殖细胞肿瘤的诊断和治疗（附38例临床分析）

目的 临床分析颅内生殖细胞肿瘤。方法 回顾10年间病理证实的38例颅内生殖细胞肿瘤,鞍区12例,基底节8例,三脑室5例,松果体区4例,其他部位包括下丘脑等。结果 手术切除32例,单纯活检6例;术后行放疗26例,其中4例接受化疗。随访18例,其中活检后行放疗4例,均恢复正常生活。结论 颅内生殖细胞肿瘤的首选治疗方法是放疗,采用局部肿瘤照射,手术的目的主要在于明确肿瘤的性质,为放化疗提供依据,除成熟的畸胎瘤外无需做到手术全切。     

瘤内切瘤技术在巨大颅内肿瘤切除中的应用

目的探讨瘤内切瘤技术在巨大型颅内肿瘤切除中的应用价值。方法采用瘤内切瘤技术切除28例最大径≥6 cm的颅内巨大型肿瘤,技术要点包括:首先建立一有效的最小创伤的显露通道(入路);肿瘤起始显露应以适宜实施瘤内切除即可:对有明显瘤蒂的脑膜瘤应从蒂部开始,否则则从瘤中央开始,采取层层推进式切除;最后在牵引瘤壁下显微分离、切除瘤壁。结果共28例巨大肿瘤中19例获全切,8例获全切,1例获大部分切除。至最近随访(平均随访10.2个月),Kamofskv计分平均92.1分,较术前平均提高20分,无新的神经功能损伤,无脑脊液漏,无死亡。1例发生脑室内感染,经强力抗感染控制,1例发生瘤腔积血再手术清除,2例胶质瘤复发分别于术后4、11个月再次手术。结论在巨大型脑肿瘤切除中,充分实施瘤内切瘤技术,可实现肿瘤较好切除同时,显著减术中神经血管结构损伤,获得更佳疗效,该技术有较大推广应用价值。     

神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤

目的:探讨神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤的治疗效果及应用价值。方法:应用神经内窥镜辅助显微外科手术治疗桥脑小脑角区胆脂瘤20例,均采用乙状窦后入路。结果:显微镜下手术后应用0°、30°内窥镜观察,20例均有不同程度的肿瘤残留。神经内窥镜辅助下继续行残余肿瘤切除,全切18例,次全切2例。术后无死亡及无菌性脑膜炎表现。术后3个月,随访16例患者,均恢复正常生活。结论:经乙状窦后入路的神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤,可提高肿瘤切除率,减少对脑干及颅神经的牵拉和对重要血管的损伤,降低手术危险性及术后并发症,提高手术疗效,缩短住院时间。     

松果体区肿瘤诊治策略的探讨

目的 探讨松果体区肿瘤的诊治策略.方法 回顾性分析154例松果体区肿瘤的病例资料.结果 松果体区肿瘤多以颅高压、眼球运动障碍起病,诊断需进行CT、MRI及肿瘤标记物检查.基本确诊或高度怀疑生殖细胞瘤时直接放疗或活检后放疗23例,肿瘤均消失,5年生存率88.9%;其他肿瘤手术治疗131例,肿瘤全切除124例,次全切除7例,5年生存率84.4%.手术患者的病理结果:生殖细胞肿瘤60例,松果体实质肿瘤17例,神经上皮肿瘤27例,其他肿瘤27例.结论 松果体区肿瘤常合并脑积水,影像学表现有一定特征,联合肿瘤标记物检测能进一步鉴别肿瘤性质.基本确诊生殖细胞瘤直接选择放、化疗,高度怀疑生殖细胞瘤选择活检后放疗或实验性放疗,不能确定生殖细胞瘤时选择显微手术联合术后辅助放、化疗,在治疗过程中兼顾脑积水的处理是较理想的松果体区肿瘤的治疗策略.

Abstract：

Objective To define the optimal diagnosis and theraputic strategy of pineal region tumors.Method Clinical materials of 154 cases with pineal region tumors were analyzed retrospectively.Results The patients with pineal region tumors often complained with increased intracranial pressure and ocular movement deficiency.The procedure of diagnosis was imaging checking included CT and MRI,tumor mark testing.23 cases which were essential exact diagnosed or high doubt germinomas were choosed to direct radiotherapy or radiotherapy after biopsy.All the tumors disappeared during the follow up time.5 years survival rate was 88.9%.Other 131 cases were chosen for operation treatment.Total removal were achieved in 124 cases and subtotal were achieved in 7 cases.The 5 years survival rate was 84.4%.The operation pathological result included 60 germ cell tumors, 17 pineal parenchymal tumors, 27 neural epithelium tumors and 27 other tumors.Conclusions Pineal region tumors are often combined with hydrocephalus.There was some characteristic feature in the imaging appearance.The cases should be chosen to direct radiotherapy and chemotherapy if was diagnosed germinomas, and be choosed to radiotherapy after biopsy or experimental radiotherapy if was high doubt germinomas.The cases which unable determined germionmas should be choosed microsurgery and assist radiotherapy and chemotherapy postoperation.Hydrocephalus should be treated in consideration during the procedure of tumor treatment.     

神经内窥镜技术的临床应用

目的探讨微侵袭内窥镜神经外科的手术技术方法.方法应用单纯内窥镜手术(EN),内窥镜辅助的显微神经外科(EAM),内窥镜控制的显微神经外科(ECM),并结合立体定向、激光等技术,治疗各种神经外科疾病84例.其中各类颅内囊肿33例,脑囊虫6例,脑积水16例,颅内肿瘤15例,颅内血肿8例,立体定向和姑息性手术6例.结果对颅内囊肿应用EN治疗21例,ECM10例,EAM2例,其中30例术前症状改善;颅内肿瘤用EN切除1例(1.5cm直径),ECM全切5例,EAM全切9例,其中13例症状缓解,1例无变化;6例脑囊虫均用EN摘除,效果良好,无并发症;其余30例(脑积水、活检、血肿、肿瘤姑息手术)均行EN手术,26例改善症状.84例中有4例出现并发症,包括蛛网膜下腔出血、脑室内出血和一过性心肺功能异常.结论 (1)神经内窥镜对颅内囊性病变、脑室内病灶、脑积水、脑囊虫和颅内深在的小病灶有独到的价值.(2)神经内窥镜对显微外科手术有辅助作用,可以提高手术质量.(3)神经内窥镜手术操作简便、损伤小、术后反应轻,可减少治疗费用,缩短住院时间.     

Clinical significance of beta 2-microglobulin and carcinoembryonic antigen in intracranial tumors

Beta 2-microglobulin (beta 2-MG) levels were determined in serum, cerebrospinal fluid (CSF), and tumor cyst fluid obtained from patients with a variety of intracranial tumors. In addition, a simultaneous determination of the carcinoembryonic antigen (CEA) was carried out in some patients. The beta 2-MG levels were elevated in 11/101 intracranial tumors, including glioma (4/34), non-glial tumors (1/18), malignant lymphoma (2/18), and metastatic brain tumors (4/31). There were no significant differences in the beta 2-MG levels of serum among the different patient groups. On the other hand, the beta 2-MG levels in CSF were significantly higher in patients with malignant lymphoma and metastatic brain tumors than in those with glioma and non-glial tumors. Fifteen (83.3%) of 18 patients with malignant lymphoma and 6(25.0%) of 24 patients with metastatic brain tumors showed increased the levels of beta 2-MG in CSF. The beta 2-MG levels in the tumor cyst fluid of 11 intracranial tumors exceeded normal serum levels in all but two patients. When the CEA levels in the serum and CSF were measured simultaneously, meaningful differences between malignant lymphoma and metastatic brain tumors were clearly observed. The highest incidence and highest levels of the CEA in serum and CSF were only noted in patients with metastatic brain tumors. Conversely, the serum CEA was slightly raised in 11.8% of malignant lymphoma and the levels of CEA in CSF were within normal range in all these patients. Serial determination of CSF beta 2-MG in patients with malignant lymphoma correlated well with their clinical findings.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinico-biological behavior of germ-cell tumors

Fifty-five patients with intracranial germ-cell tumors were treated in Kobe University Hospital between 1972 and 1989. Thirty-four patients were male and 21 were female, and all patients were between 0 and 39 years of age. There was a peak incidence between 16 and 20 years in male patients and 11 and 15 years in female patients. The tumors occurred most frequently in the pineal region (25 cases), followed by the suprasellar (17), both pineal and suprasellar (6), basal ganglia (5), and frontal and temporal lobe (2) regions. There was a male predominance in the incidence of germ-cell tumors except for the patients with suprasellar tumors. Initial symptoms and neurological signs differed according to the location of the tumor. The symptoms of increased intracranial pressure and Parinaud's sign were most frequently seen in patients with a pineal tumor, while diabetes insipidus and visual disturbance were most common in patients with suprasellar tumors. Human chorionic gonadotropin were positive in the serum, cerebrospinal fluid and/or tumor cyst in 14/26 patients, and alpha-fetoprotein in 6/22 patients examined. There were 45 patients with pure germinoma both histologically verified and clinically diagnosed. The 5-year survival rate of the patients with germinoma was 69% in cases in which tumor marker was negative and unknown cases, and 86% in cases where the tumor marker was positive. The authors discuss management of the patients with intracranial germ-cell tumors.Presented at the XVIII Annual Meeting of the International Society for Pediatric Neurosurgery, Paris 1990