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.     

儿童第四脑室肿瘤显微外科治疗策略

目的探讨儿童第四脑室肿瘤的生物学特点及显微外科治疗策略。方法 1998年至2009年收治的儿童第四脑室肿瘤患者45例,对其病理特点、临床表现、影像学变化、手术操作和预后等方面进行回顾性分析。结果肿瘤全切除36例,次全切除及大部切除9例;术后病理示髓母细胞瘤28例,室管膜瘤14例,星形细胞瘤3例;术后临床症状好转32例,无改善10例,恶化2例,1例患者死于严重脑干水肿;术后复查有4例因脑积水行脑室-腹腔分流术。结论儿童第四脑室肿瘤首发症状多种多样,MRI对于诊断与手术有重要的意义,采取合适的显微神经外科策略是提高手术疗效的关键。     

颈髓髓内肿瘤的显微外科治疗

目的 探讨颈髓髓内肿瘤的临床特征、手术时机和手术技巧。方法 回顾性分析21例颈髓髓内肿瘤的病理类型、临床表现、手术切除程度及临床疗效。结果肿瘤镜下全切除14例（室管膜瘤8例、星形细胞瘤3例、血管母细胞瘤3例）,次全切除5例（室管膜瘤2例、星形细胞瘤3例）,部分切除或活检2例（均为星彤细胞瘤）。1例死于术后呼吸功能障碍。术后随访3个月-5年,平均25个月,神经系统症状好转13例,无改善3例,加重1例,失访3例。结论 绝大多数颈髓髓内肿瘤可通过显微外科手术切除,对恶性肿瘤及未全切除的肿瘤应辅以放射治疗。     

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。     

神经内窥镜下手术切除脑室内肿瘤

脑室肿瘤的手术对于神经外科医师是一具有挑战性的课题,由于肿瘤位置深,必然会带来一定的手术死亡率和致残率。采用神经内镜下手术可以切除某些脑室内肿瘤,治疗的效果和显微神经外科手术效果相当,而对正常脑组织损伤更轻。本文报道经内窥镜下连续手术治疗的30例全脑室内肿瘤,以确定内窥镜下治疗脑室内肿瘤的有效性。 临床资料和方法;1993.2～1996.10。30例入住神经外科的脑室内病变患者,男19例,女11例,年龄4～62岁,平均33.7岁。其中胶样囊肿7例,星形细胞瘤6例,松果体区肿瘤4例,室管膜瘤2例,室管膜下瘤3例,脉络丛乳头状瘤、髓母细胞瘤、垂体腺瘤、海绵状血     

侧脑室内肿瘤的显微外科治疗(附28例报告)

目的探讨侧脑室内肿瘤的临床特征和个体化显微手术策略及疗效。方法回顾性分析2002年9月至2009年6月手术治疗并经病理证实的28例侧脑室内肿瘤患者的临床资料。结果肿瘤全切除22例,次全切3例,大部分切除3例。经病理学证实室管膜瘤8例,脉络丛乳头状瘤4例,脑膜瘤6例,少枝胶质细胞瘤4例,星形细胞瘤3例,中枢神经细胞瘤2例,胶质母细胞瘤1例。1例因术后硬膜下血肿再次手术,7例因脑积水而行脑室-腹腔分流术,5例术后出现颅内感染,1例因严重感染并脑积水死亡。术后配合放疗和/或化疗19例。术后随访6个月至3年,2例轻残,10例生活自理,15例可参加日常工作。结论侧脑室内肿瘤的位置、大小和血供影响手术入路、疗效和病人预后。适宜的手术入路和显露,恰当的导航辅助可避免损害脑功能,提高肿瘤切除程度;恶性肿瘤术后行个体化放疗和/或化疗,可显著改善病人预后。     

第四脑室室管膜瘤的临床特点和治疗(附19例临床分析)

目的探讨第四脑室室管膜瘤的临床特点和治疗方法。方法回顾性分析2011年1月至2015年12月安徽省立医院收治的19例第四脑室室管膜瘤患者的临床特点、治疗和预后。结果首发症状多为头痛、呕吐等高颅压症状,常伴有梗阻性脑积水。本组患者肿瘤全切除12例,次全切除4例,大部切除2例,部分切除1例。无手术死亡病例。术后接受放疗9例,3例还接受了化疗。术后随访16例,平均随访36.2个月,复发5例,再次手术2例,死亡4例。结论第四脑室室管膜瘤容易复发,治疗应采用手术联合放疗。复发患者可再次手术。     

手术治疗后颅窝肿瘤45例临床分析

目的探讨后颅窝肿瘤特点及显微手术方法、疗效。方法回顾性分析显微手术治疗45例后颅窝肿瘤的临床资料。结果病理结果包括:星形细胞瘤、髓母细胞瘤、室管膜瘤、血管母细胞瘤、胆脂瘤、畸胎瘤、脑膜瘤、听神经瘤、血管畸形。肿瘤全切除25例,次全切除14例,大部分切除6例,术后死亡2例。结论后颅窝结构复杂手术难度较大,术后并发症发生率高。掌握手术原则,采用合理的手术技巧和术式,注意术中肿瘤切除与功能的保护,减少并发症,降低病死率,提高生存质量。     

小儿后颅窝中线肿瘤的显微手术治疗

目的探讨小儿后颅窝中线肿瘤的临床特点和显微手术疗效。方法回顾性分析2011年2月至2015年2月显微手术治疗的52例小儿后颅窝中线肿瘤的临床资料。结果肿瘤全切除45例,次全切除5例,大部分切除2例。髓母细胞瘤36例(69.2%),室管膜瘤及间变性室管膜瘤7例(13.5%),星形细胞瘤7例(13.5%),少突胶质细胞瘤1例(1.9%),血管母细胞瘤1例(1.9%)。围手术期并发症发生率为44.2%(23/52)。术后无并发症短期内恢复良好29例,出现并发症延迟恢复19例,昏迷自动出院或死亡4例。康复的48例出院后随访3~48个月,平均15个月;7例肿瘤复发。结论显微手术是治疗小儿后颅窝中线肿瘤最有效的方法,术中利用小脑延髓裂间隙显露切除肿瘤能有效减少脑组织损伤,加强围手术期并发症的处理可提高疗效。     

脊髓髓内肿瘤的显微外科治疗

目的 总结脊髓髓内肿瘤的治疗经验.方法 回顾性分析36例经显微手术治疗的脊髓髓内肿瘤病人的临床资料,术中超声辅助定位5例.结果 室管膜瘤17例,低级别星形细胞瘤(WHO I ～II级)8例,高级别星形细胞瘤(WHO Ⅲ～Ⅳ级)3例,血管母细胞瘤3例,海绵状血管瘤2例,脂肪瘤、转移瘤、畸胎瘤各1例.室管膜瘤全切率82.4%,低级别星形细胞瘤为50.0%,高级别星形细胞瘤为33.3%,血管母细胞瘤、海绵状血管瘤和转移瘤均全切,脂肪瘤和畸胎瘤次全切.术后随访3个月,根据McCormick脊髓功能状态分级:I级23例,II级7例,Ⅲ级3例,Ⅳ级3例.结论 显微手术切除脊髓髓内肿瘤是目前最有效的治疗措施.术中超声有助于术中肿瘤定位,减少手术创伤.     

Therapeutic results of eight patients with intracranial ependymomas]

Between 1985 and 2001, eight patients with intracranial ependymomas underwent surgery at our hospital. The cases included six infratentorial ependymomas, one supratentorial ependymoma and one supratentorial anaplastic ependymoma. Infratentorial ependymomas were classified according to origin and extension. The lateral type tumors originated from the lateral part of the fourth ventricle in four cases. The midfloor type tumors originated from the inferior half of the fourth ventricular floor in two cases. The three totally resected tumors were the lateral type tumors. The remaining one case with the lateral type tumor underwent nearly total resection of the tumor, since the tumor involved lower cranial nerves. All patients with the midfloor type tumors underwent incomplete resections of the tumors, because the tumors infiltrated into brain stem. Lower cranial nerve involvement and brain stem invasion implied incomplete resection and had the poor prognosis. In intracranial ependymomas, all four patients with total resections have been alive, whereas three of four patients with incomplete resections have died. The mean survival time of all patients with intracranial ependymomas was 127 months from the time of the initial surgery. There were no deaths in the patients with tumors showing MIB-1 index < 10% (n = 4). The mean survival time of the patients with tumors showing MIB-1 index > or = 10% (n = 4), was 30 months. The extent of the resection, the age of the patients and MIB-1 index are important factors in the outcome in patients with intracranial ependymomas. Two representative children aged less than 3 years with the midfloor type tumors were presented. In a patient treated with conventional radiation and chemotherapy, residual tumor repeatedly enlarged within 12 months despite several resections of the tumor. The patient died 32 months after the initial resection. In contrast, the other patient received multidisciplinary treatment including Linac stereotactic radiotherapy (SRT) with a marginal dose of 27 Gy in 9 fractions, have been still alive for 45 months after the initial resection. The residual tumor slightly decreased in size and remained stable without evident growth 12 months after SRT. SRT may provide good local control for patients with intracranial ependymomas and have a favorable impact on survival.     

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。     

VM26联合MeCCNU在人脑低级别胶质瘤治疗中应用的初步探讨

目的 探讨人脑胶质瘤手术切除和放疗后O6-甲基鸟嘌呤DNA甲基转移酶(MGMT)阳性的低级别胶质瘤患者应用替尼泊甙(VM26)+甲基环亚硝脲(MeCCNU)联合治疗疗效.方法 总结分析我科2005.01-2008.10年收治的资料较完整、全切肿瘤22例,MRI增强扫描未见肿瘤征像,术后病理证实免疫组化MGMT阳性的弥漫...     

Ganglioglioma espinal intramedular: caso clínico y revisión comparativa de la literatura

IntroductionIntramedullary spinal cord gangliogliomas (ISCGGs) account for 35-40% of all intramedullary tumors in children. These tumors have a different algorithm for treatment and prognosis than other medullary tumors, such as astrocytomas and spinal ependymomas. The objective of the study was to review the literature and examine an approach to diagnosing and treating this tumor based on a case report of ISCGG diagnosed at our center.MethodAn exhaustive review of cases of ISCGG published via the PubMed-NCBI platform between 1911 and 2018 was performed, and each patient's epidemiological characteristics, tumor location, symptoms, radiological diagnosis and treatment were appended.ResultsA total of 167 cases of ISCGG were found, including our own. In our sample, 52% of patients were female and the most commonly affected age group was 0-9 years of age (35% of patients). Motor deficit has been found to be the main symptom in a larger proportion of adults patients versus pediatric patients. On X-ray, this tumor shows greater hyperintensity and contrast uptake than astrocytomas and ependymomas, as well as a higher percentage of intratumoral cysts. The BRAF^V600E mutation is less common in spinal as opposed to supratentorial gangliogliomas. Surgery with complete resection is the treatment of choice. Only 19% of the patients in the sample received radiotherapy, and only 9% received chemotherapy as their only line of treatment.ConclusionsISCGGs are common in the pediatric population and require strong suspicion for proper diagnosis and treatment, as the risk of recurrence of ISCGGs is 3 times greater than that of supratentorial gangliogliomas.     

儿童鞍区肿瘤的治疗策略

目的探讨儿童鞍区肿瘤的诊断、手术治疗及效果。方法回顾性分析我院自2014年1月至2017年5月170例儿童鞍区肿瘤资料,根据肿瘤的具体位置及大小选择手术入路,其中额下入路90例、翼点入路30例、纵裂-胼胝体入路30例、额下联合纵裂入路20例。术后病理诊断颅咽管瘤90例,生殖细胞瘤45例,视神经胶质瘤20例,垂体瘤8例,下丘脑错构瘤7例。结果全切132例,次全切23例,大部分切除15例,术后死亡4例。出院后随访3个月~3年,术后接受放化疗72例,肿瘤复发25例,再次手术10例。结论根据肿瘤生长位置和大小选择合适手术入路,提高全切率是儿童鞍区肿瘤治疗的关键,术后的放化疗亦不容忽视。     

Malignant hemispheric tumors in childhood

Sixty-four malignant hemispheric tumors in children less than 15 years old were treated in the pediatric neurosurgical department of the H ôpital des Enfants Malades between 1970 and 1989. (1) These tumors evolved rapidly in most cases. However the pre-operative evolution in 20% of the patients had a duration of more than 6 months, which favors the hypothesis that at least one-fifth of these tumors result from malignant transformation of a benign lesion. This observation should prompt neurosurgeons to operate on all benign hemispheric tumors as soon as they are diagnosed. (2) Five of the 64 patients had two successive malignant diseases. In four cases the other malignant disease was an acute lymphoblastic leukemia. (3) Among the malignant hemispheric tumors, the grade III and IV astrocytomas had a dismal prognosis. As it is known from previous studies that grade I and II astrocytomas have a good prognosis in children, it can be concluded that grading these tumors is essential. By contrast, almost one out of two patients with malignant ependymoma was alive 5 years after treatment. This implies that the grading of ependymomas is of modest prognostic values. (4) The harmful effect of radiotherapy was evaluated by comparing the functional outcome of children operated for a benign hemispheric tumor to that of children operated and irradiated for a malignant hemispheric tumor.     

幕上脑实质内室管膜瘤14例临床分析

目的 探讨幕上脑实质内室管膜瘤的临床特点、影像学表现、治疗和预后.方法 对经手术后病理证实的14例幕上脑实质内室管膜瘤进行临床分析.其中室管膜瘤10例,恶性室管膜瘤4例.肿瘤位于额叶4例,顶叶8例,枕叶2例.肿瘤呈完全实质性者3例,囊性变者11例.结果 全部病例均手术切除.全切除10例,次全切除4例.随访时间3个月-4年.3例患者复发后行二次手术,其中1例患者手术后4个月死亡;1例患者复发后拒绝再次手术后6个月死亡,12例患者目前仍存活.结论 幕上脑实质内室管膜瘤术前诊断较困难,应注意与其他肿瘤相鉴别.手术全切除效果良好,神经导航辅助下的显微手术有助于手术全切除.

Abstract：

Objective To study the clinical feature, image, treatment and prognosis of supratentorial parenchymal ependymomas. Method 14 cases of patients suffered from supratentorial parenchymal ependymomas were treated. There were 10 ependymomas and 4 malignant ependymomas. Tumor was located in frontal lobe in 4cases,parietal in 8,and occipital in 2. There were 3 substantial tumors and 11 cystic tumors. Results All the patients received operation. Complete surgical removal was achieved in 10 cases and partial removal in 4. All the cases were followed-up from 3 months to 4 years. 3 patients with recurrent tumors received the second operation,among them one patient died after 4 months. One patient with recurrent tumor did not receive the second operation and died after 6 months. 12 patients were still alive. Conclusions The preoperative diagnosis of supratentorial parenchymal ependymomas is difficult. Complete removal of tumor is important for good prognosis. Microsurgical techniques combined with navigation are helpful for complete removal of tumor.